- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.67 / $4,761.00 / $8,451.00
| Facility | | $1,088.67 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.21 / $1,115.52 / $1,515.47
| Professional | | $986.21 | $1,115.52 | $1,515.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.08 / $1,687.51 / $2,254.78
| Professional | | $1,072.08 | $1,687.51 | $2,254.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.69 / $1,567.27 / $2,450.84
| Professional | | $1,156.69 | $1,567.27 | $2,450.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.60 / $1,905.94 / $1,905.94
| Professional | | $1,433.60 | $1,905.94 | $1,905.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.67 / $5,342.00 / $9,617.00
| Facility | | $1,088.67 | $5,342.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.02 / $1,217.34 / $3,183.38
| Professional | | $1,014.02 | $1,217.34 | $3,183.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,403.50 / $3,067.50
| Professional | | $6.00 | $1,403.50 | $3,067.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.18 / $1,577.36 / $2,653.24
| Professional | | $1,158.18 | $1,577.36 | $2,653.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.74 / $1,200.31 / $1,327.51
| Facility | | $1,032.74 | $1,200.31 | $1,327.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.74 / $1,211.19 / $1,327.51
| Professional | | $1,032.74 | $1,211.19 | $1,327.51 |
- 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
- $1,152.53 / $1,537.60 / $2,468.44
| Professional | | $1,152.53 | $1,537.60 | $2,468.44 |