- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.85 / $2,723.00 / $5,039.00
| Facility | | $1,334.85 | $2,723.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.21 / $959.85 / $1,443.52
| Professional | | $828.21 | $959.85 | $1,443.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.86 / $4,287.00 / $12,124.49
| Facility | | $1,012.86 | $4,287.00 | $12,124.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.89 / $1,629.17 / $11,926.99
| Professional | | $943.89 | $1,629.17 | $11,926.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,205.15 / $1,786.92 / $2,420.66
| Professional | | $1,205.15 | $1,786.92 | $2,420.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.03 / $1,547.29 / $2,646.65
| Professional | | $943.03 | $1,547.29 | $2,646.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.62 / $1,811.48 / $6,679.00
| Facility | | $920.62 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.41 / $1,279.66 / $1,748.44
| Professional | | $1,056.41 | $1,279.66 | $1,748.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.52 / $2,276.83 / $3,003.49
| Professional | | $1,148.52 | $2,276.83 | $3,003.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,983.00 / $11,272.00
| Facility | | $55.00 | $4,983.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.31 / $1,692.21 / $11,926.99
| Professional | | $1,009.31 | $1,692.21 | $11,926.99 |
- 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
- $999.36 / $1,458.52 / $2,860.50
| Professional | | $999.36 | $1,458.52 | $2,860.50 |