- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.19 / $5,254.00 / $10,398.00
| Facility | | $1,066.19 | $5,254.00 | $10,398.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.95 / $970.54 / $1,267.22
| Professional | | $888.95 | $970.54 | $1,267.22 |
- 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
- $863.27 / $1,407.59 / $1,899.18
| Professional | | $863.27 | $1,407.59 | $1,899.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.27 / $1,291.69 / $2,008.35
| Professional | | $949.27 | $1,291.69 | $2,008.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.74 / $1,540.96 / $1,549.01
| Professional | | $1,161.74 | $1,540.96 | $1,549.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,511.00 / $11,083.00
| Facility | | $1,301.00 | $5,511.00 | $11,083.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.95 / $1,066.19 / $5,233.38
| Professional | | $888.95 | $1,066.19 | $5,233.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,255.50 / $2,564.00
| Professional | | $5.00 | $1,255.50 | $2,564.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.76 / $1,295.67 / $2,181.81
| Professional | | $954.76 | $1,295.67 | $2,181.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.86 / $973.86 / $1,355.32
| Facility | | $973.86 | $973.86 | $1,355.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.20 / $974.39 / $1,355.32
| Professional | | $948.20 | $974.39 | $1,355.32 |
- 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
- $898.37 / $1,231.00 / $1,966.34
| Professional | | $898.37 | $1,231.00 | $1,966.34 |