- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.16 / $5,087.00 / $8,920.00
| Facility | | $1,432.16 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.30 / $1,286.53 / $1,487.13
| Professional | | $1,096.30 | $1,286.53 | $1,487.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.99 / $1,148.69 / $1,620.74
| Professional | | $924.99 | $1,148.69 | $1,620.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.46 / $1,393.46 / $5,895.00
| Professional | | $1,393.46 | $1,393.46 | $5,895.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.75 / $1,420.75 / $1,420.75
| Facility | | $1,420.75 | $1,420.75 | $1,420.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.32 / $1,438.67 / $2,503.96
| Professional | | $1,020.32 | $1,438.67 | $2,503.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.26 / $1,458.26 / $1,736.02
| Professional | | $1,313.26 | $1,458.26 | $1,736.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.46 / $1,432.16 / $1,928.64
| Facility | | $1,097.46 | $1,432.16 | $1,928.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.00 / $1,877.97 / $2,938.34
| Professional | | $695.00 | $1,877.97 | $2,938.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,009.31 / $1,559.22 / $7,030.19
| Facility | | $1,009.31 | $1,559.22 | $7,030.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.31 / $1,559.22 / $7,030.19
| Professional | | $1,009.31 | $1,559.22 | $7,030.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,270.00 / $17,192.00
| Facility | | $6,303.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.95 / $1,281.78 / $2,262.66
| Professional | | $922.95 | $1,281.78 | $2,262.66 |