- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $8,271.00
| Facility | | $2,618.00 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.95 / $999.92 / $1,529.12
| Professional | | $876.95 | $999.92 | $1,529.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.10 / $5,268.00 / $15,220.00
| Facility | | $1,609.10 | $5,268.00 | $15,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.76 / $1,733.34 / $7,220.28
| Professional | | $991.76 | $1,733.34 | $7,220.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.73 / $1,891.56 / $2,862.89
| Professional | | $1,275.73 | $1,891.56 | $2,862.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.08 / $1,639.57 / $2,799.42
| Professional | | $998.08 | $1,639.57 | $2,799.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.35 / $1,909.00 / $7,315.92
| Facility | | $974.35 | $1,909.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.07 / $1,354.35 / $1,850.83
| Professional | | $1,118.07 | $1,354.35 | $1,850.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.28 / $2,409.17 / $3,178.08
| Professional | | $1,215.28 | $2,409.17 | $3,178.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,471.58 / $26,542.00
| Facility | | $2,155.00 | $5,471.58 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.23 / $1,789.76 / $7,220.28
| Professional | | $1,070.23 | $1,789.76 | $7,220.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,041.96 / $1,509.57 / $2,853.59
| Professional | | $1,041.96 | $1,509.57 | $2,853.59 |