- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $8,296.87
| Facility | | $2,618.00 | $3,111.85 | $8,296.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.69 / $948.05 / $2,355.53
| Professional | | $873.69 | $948.05 | $2,355.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.00 / $5,457.42 / $16,742.00
| Facility | | $1,939.00 | $5,457.42 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.33 / $1,945.38 / $8,240.67
| Professional | | $954.33 | $1,945.38 | $8,240.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.74 / $1,907.74 / $1,907.74
| Professional | | $1,907.74 | $1,907.74 | $1,907.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.06 / $2,086.62 / $3,794.60
| Professional | | $1,261.06 | $2,086.62 | $3,794.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.35 / $1,909.00 / $7,315.92
| Facility | | $982.35 | $1,909.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.25 / $1,424.41 / $2,546.73
| Professional | | $1,127.25 | $1,424.41 | $2,546.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.51 / $2,426.21 / $3,233.48
| Professional | | $1,216.51 | $2,426.21 | $3,233.48 |
- 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
- $1,145.27 / $2,183.23 / $8,240.67
| Professional | | $1,145.27 | $2,183.23 | $8,240.67 |
- 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
- $1,132.03 / $1,728.93 / $3,497.24
| Professional | | $1,132.03 | $1,728.93 | $3,497.24 |