- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.42 / $3,107.00 / $7,625.00
| Facility | | $2,278.42 | $3,107.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.90 / $1,712.12 / $3,213.74
| Professional | | $741.90 | $1,712.12 | $3,213.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $5,097.00 / $13,773.00
| Facility | | $1,591.00 | $5,097.00 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.43 / $2,742.03 / $12,605.52
| Professional | | $970.43 | $2,742.03 | $12,605.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.35 / $1,165.94 / $2,313.73
| Facility | | $907.35 | $1,165.94 | $2,313.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.88 / $2,193.32 / $4,783.37
| Professional | | $970.88 | $2,193.32 | $4,783.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.69 / $1,654.46 / $7,315.92
| Facility | | $768.69 | $1,654.46 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.81 / $2,480.11 / $3,447.12
| Professional | | $2,032.81 | $2,480.11 | $3,447.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.94 / $2,170.92 / $5,025.43
| Professional | | $1,043.94 | $2,170.92 | $5,025.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,380.77 / $7,380.77 / $7,380.77
| Facility | | $7,380.77 | $7,380.77 | $7,380.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,297.46 / $26,542.00
| Facility | | $2,324.00 | $5,297.46 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.04 / $4,023.45 / $12,605.52
| Professional | | $1,815.04 | $4,023.45 | $12,605.52 |
- 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
- $1,491.78 / $2,916.62 / $6,477.40
| Professional | | $1,491.78 | $2,916.62 | $6,477.40 |