- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,331.37 / $4,761.00 / $8,451.00
| Facility | | $1,331.37 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.15 / $1,209.00 / $1,581.27
| Professional | | $1,109.15 | $1,209.00 | $1,581.27 |
- 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
- $1,076.17 / $1,626.18 / $2,603.77
| Professional | | $1,076.17 | $1,626.18 | $2,603.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.09 / $1,586.56 / $2,574.73
| Professional | | $1,094.09 | $1,586.56 | $2,574.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.47 / $1,922.57 / $1,934.39
| Professional | | $1,449.47 | $1,922.57 | $1,934.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,342.00 / $9,617.00
| Facility | | $1,151.00 | $5,342.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.15 / $1,292.50 / $5,958.00
| Professional | | $1,109.15 | $1,292.50 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,449.90 / $3,206.00
| Professional | | $5.00 | $1,449.90 | $3,206.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.33 / $1,595.23 / $2,689.66
| Professional | | $1,190.33 | $1,595.23 | $2,689.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.73 / $1,215.73 / $1,415.73
| Facility | | $1,215.73 | $1,215.73 | $1,415.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.18 / $1,215.90 / $1,415.73
| Professional | | $1,184.18 | $1,215.90 | $1,415.73 |
- 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
- $1,074.07 / $1,518.46 / $2,434.37
| Professional | | $1,074.07 | $1,518.46 | $2,434.37 |