- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $4,806.64
| Facility | | $1,421.00 | $2,663.12 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.70 / $1,056.51 / $2,415.73
| Professional | | $964.70 | $1,056.51 | $2,415.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.97 / $4,916.00 / $15,093.22
| Facility | | $1,634.97 | $4,916.00 | $15,093.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,013.75 / $1,890.64 / $9,057.00
| Professional | | $1,013.75 | $1,890.64 | $9,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.06 / $1,771.29 / $3,009.77
| Professional | | $1,040.06 | $1,771.29 | $3,009.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.21 / $1,811.48 / $6,679.00
| Facility | | $989.21 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,135.11 / $1,375.00 / $1,878.61
| Professional | | $1,135.11 | $1,375.00 | $1,878.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.79 / $2,418.11 / $3,189.87
| Professional | | $1,219.79 | $2,418.11 | $3,189.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.44 / $5,540.44 / $5,540.44
| Facility | | $5,540.44 | $5,540.44 | $5,540.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,459.52 / $16,394.00
| Facility | | $2,324.00 | $5,459.52 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.60 / $1,928.86 / $9,057.00
| Professional | | $1,145.60 | $1,928.86 | $9,057.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $17,116.25
| Facility | | $2,324.00 | $6,280.00 | $17,116.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.40 / $1,603.85 / $3,321.16
| Professional | | $1,025.40 | $1,603.85 | $3,321.16 |