- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.00 / $3,745.00 / $8,017.00
| Facility | | $1,084.00 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.98 / $1,446.18 / $1,995.36
| Professional | | $1,233.98 | $1,446.18 | $1,995.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,407.75 / $1,460.88 / $1,460.88
| Professional | | $1,407.75 | $1,460.88 | $1,460.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.61 / $1,842.61 / $2,875.99
| Professional | | $1,359.61 | $1,842.61 | $2,875.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.41 / $2,163.27 / $2,168.94
| Professional | | $1,635.41 | $2,163.27 | $2,168.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,017.00
| Facility | | $1,013.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.98 / $1,512.46 / $4,671.72
| Professional | | $1,233.98 | $1,512.46 | $4,671.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,944.50 / $3,491.30
| Professional | | $3.00 | $1,944.50 | $3,491.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,394.48 / $1,844.76 / $3,156.37
| Professional | | $1,394.48 | $1,844.76 | $3,156.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.47 / $1,370.47 / $1,755.78
| Facility | | $1,370.47 | $1,370.47 | $1,755.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,327.92 / $1,378.25 / $1,755.78
| Professional | | $1,327.92 | $1,378.25 | $1,755.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.85 / $1,740.73 / $2,909.66
| Professional | | $1,405.85 | $1,740.73 | $2,909.66 |