- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $2,747.00 / $8,017.00
| Facility | | $1,020.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.85 / $1,069.33 / $2,726.23
| Professional | | $939.85 | $1,069.33 | $2,726.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.58 / $1,682.05 / $2,190.46
| Professional | | $1,045.58 | $1,682.05 | $2,190.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.72 / $1,377.33 / $2,310.71
| Professional | | $1,035.72 | $1,377.33 | $2,310.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.18 / $1,676.48 / $1,676.48
| Professional | | $1,255.18 | $1,676.48 | $1,676.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $3,120.00 / $8,017.00
| Facility | | $954.00 | $3,120.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.85 / $1,110.22 / $3,261.44
| Professional | | $939.85 | $1,110.22 | $3,261.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $1,150.40 / $2,661.80
| Professional | | $4.00 | $1,150.40 | $2,661.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.72 / $1,402.37 / $2,310.71
| Professional | | $1,035.72 | $1,402.37 | $2,310.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.89 / $1,026.89 / $1,041.29
| Facility | | $1,026.89 | $1,026.89 | $1,041.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.20 / $1,039.22 / $1,082.75
| Professional | | $988.20 | $1,039.22 | $1,082.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.00 / $2,391.00 / $4,789.00
| Facility | | $912.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.20 / $1,341.74 / $2,119.26
| Professional | | $996.20 | $1,341.74 | $2,119.26 |