- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.85 / $5,254.00 / $11,022.00
| Facility | | $1,103.85 | $5,254.00 | $11,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.32 / $1,007.12 / $1,315.70
| Professional | | $921.32 | $1,007.12 | $1,315.70 |
- 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
- $898.66 / $1,460.80 / $1,969.78
| Professional | | $898.66 | $1,460.80 | $1,969.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.16 / $1,331.63 / $2,079.31
| Professional | | $975.16 | $1,331.63 | $2,079.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.69 / $1,603.35 / $1,610.07
| Professional | | $1,208.69 | $1,603.35 | $1,610.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,201.27 / $14,201.27 / $14,201.27
| Facility | | $14,201.27 | $14,201.27 | $14,201.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,742.00 / $12,474.00
| Facility | | $1,301.00 | $5,742.00 | $12,474.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.32 / $1,078.41 / $5,424.22
| Professional | | $921.32 | $1,078.41 | $5,424.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,229.40 / $2,651.70
| Professional | | $5.00 | $1,229.40 | $2,651.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $992.18 / $1,334.43 / $2,199.15
| Professional | | $992.18 | $1,334.43 | $2,199.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.67 / $1,010.67 / $1,074.08
| Facility | | $1,010.67 | $1,010.67 | $1,074.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.65 / $1,011.64 / $1,074.08
| Professional | | $983.65 | $1,011.64 | $1,074.08 |
- 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
- $908.89 / $1,297.54 / $2,156.01
| Professional | | $908.89 | $1,297.54 | $2,156.01 |