- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.71 / $3,107.00 / $5,851.00
| Facility | | $1,189.71 | $3,107.00 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.09 / $747.52 / $2,162.30
| Professional | | $632.09 | $747.52 | $2,162.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,891.59 / $5,097.00 / $16,742.00
| Facility | | $1,891.59 | $5,097.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.26 / $1,633.78 / $5,960.56
| Professional | | $821.26 | $1,633.78 | $5,960.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.13 / $1,094.07 / $2,045.49
| Professional | | $778.13 | $1,094.07 | $2,045.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.71 / $1,760.32 / $3,194.95
| Professional | | $1,067.71 | $1,760.32 | $3,194.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.36 / $1,795.98 / $6,679.00
| Facility | | $827.36 | $1,795.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.40 / $1,199.67 / $2,008.49
| Professional | | $949.40 | $1,199.67 | $2,008.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.41 / $2,043.08 / $2,722.88
| Professional | | $1,024.41 | $2,043.08 | $2,722.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,849.84 / $7,849.84 / $7,849.84
| Facility | | $7,849.84 | $7,849.84 | $7,849.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $26,542.00
| Facility | | $2,324.00 | $6,280.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.12 / $1,795.98 / $5,960.56
| Professional | | $966.12 | $1,795.98 | $5,960.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.89 / $1,202.21 / $2,639.92
| Professional | | $952.89 | $1,202.21 | $2,639.92 |