- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,111.85 / $7,625.00
| Facility | | $2,663.12 | $3,111.85 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.04 / $2,385.57 / $4,167.54
| Professional | | $653.04 | $2,385.57 | $4,167.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.33 / $3,997.00 / $11,217.00
| Facility | | $1,096.33 | $3,997.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.37 / $4,242.21 / $18,277.12
| Professional | | $901.37 | $4,242.21 | $18,277.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.63 / $1,021.10 / $2,026.31
| Facility | | $794.63 | $1,021.10 | $2,026.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.73 / $2,656.16 / $7,218.05
| Professional | | $878.73 | $2,656.16 | $7,218.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.89 / $1,448.92 / $7,315.92
| Facility | | $674.89 | $1,448.92 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.33 / $3,626.38 / $5,078.22
| Professional | | $2,972.33 | $3,626.38 | $5,078.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.80 / $2,652.28 / $6,936.18
| Professional | | $917.80 | $2,652.28 | $6,936.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $26,542.00
| Facility | | $1,902.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,898.98 / $5,862.82 / $18,277.12
| Professional | | $2,898.98 | $5,862.82 | $18,277.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,449.84 / $4,349.35 / $8,249.45
| Professional | | $2,449.84 | $4,349.35 | $8,249.45 |