- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,055.16 / $3,745.00 / $8,017.00
| Facility | | $1,055.16 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.75 / $1,118.51 / $1,793.29
| Professional | | $984.75 | $1,118.51 | $1,793.29 |
- 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
- $1,173.77 / $1,218.06 / $2,171.92
| Professional | | $1,173.77 | $1,218.06 | $2,171.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.33 / $1,498.80 / $2,375.39
| Professional | | $1,107.33 | $1,498.80 | $2,375.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.40 / $1,844.35 / $1,844.35
| Professional | | $1,387.40 | $1,844.35 | $1,844.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,964.00 / $8,017.00
| Facility | | $1,013.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.75 / $1,206.43 / $3,249.98
| Professional | | $984.75 | $1,206.43 | $3,249.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,329.40 / $2,982.70
| Professional | | $3.00 | $1,329.40 | $2,982.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.08 / $1,516.43 / $2,448.48
| Professional | | $1,120.08 | $1,516.43 | $2,448.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.08 / $1,160.08 / $1,172.00
| Facility | | $1,160.08 | $1,160.08 | $1,172.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.46 / $1,169.08 / $1,218.83
| Professional | | $1,121.46 | $1,169.08 | $1,218.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.58 / $1,375.99 / $2,362.34
| Professional | | $1,073.58 | $1,375.99 | $2,362.34 |