- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.02 / $2,747.00 / $6,075.00
| Facility | | $1,030.02 | $2,747.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.08 / $726.94 / $1,758.22
| Professional | | $631.08 | $726.94 | $1,758.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $9,401.00
| Facility | | $1,485.00 | $4,402.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.99 / $1,296.29 / $5,157.76
| Professional | | $741.99 | $1,296.29 | $5,157.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.20 / $1,422.15 / $1,926.64
| Professional | | $959.20 | $1,422.15 | $1,926.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.44 / $1,210.75 / $2,039.85
| Professional | | $741.44 | $1,210.75 | $2,039.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.87 / $1,581.36 / $6,679.00
| Facility | | $721.87 | $1,581.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.35 / $1,008.12 / $1,391.60
| Professional | | $828.35 | $1,008.12 | $1,391.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.37 / $1,757.14 / $2,317.94
| Professional | | $886.37 | $1,757.14 | $2,317.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $26,542.00
| Facility | | $2,155.00 | $5,268.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.26 / $1,335.58 / $5,157.76
| Professional | | $792.26 | $1,335.58 | $5,157.76 |
- 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
- $767.65 / $1,125.38 / $2,153.63
| Professional | | $767.65 | $1,125.38 | $2,153.63 |