- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.12 / $1,121.56 / $2,874.56
| Professional | | $981.12 | $1,121.56 | $2,874.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.68 / $5,508.58 / $25,526.57
| Facility | | $1,794.68 | $5,508.58 | $25,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.99 / $1,872.85 / $7,976.49
| Professional | | $1,078.99 | $1,872.85 | $7,976.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.27 / $1,815.80 / $3,132.06
| Professional | | $1,103.27 | $1,815.80 | $3,132.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.02 / $1,909.00 / $6,679.00
| Facility | | $1,087.02 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.35 / $1,510.96 / $2,062.92
| Professional | | $1,247.35 | $1,510.96 | $2,062.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.00 / $2,690.12 / $3,548.69
| Professional | | $1,357.00 | $2,690.12 | $3,548.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.43 / $250.43 / $250.43
| Professional | | $250.43 | $250.43 | $250.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,078.00 / $26,542.00
| Facility | | $2,386.00 | $6,078.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.02 / $1,997.98 / $7,976.49
| Professional | | $1,191.02 | $1,997.98 | $7,976.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.96 / $1,661.37 / $3,379.74
| Professional | | $1,162.96 | $1,661.37 | $3,379.74 |