- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.46 / $1,008.19 / $1,515.27
| Professional | | $882.46 | $1,008.19 | $1,515.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.18 / $4,916.00 / $16,742.00
| Facility | | $1,595.18 | $4,916.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.39 / $1,895.57 / $8,915.04
| Professional | | $1,026.39 | $1,895.57 | $8,915.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.39 / $1,721.58 / $2,775.55
| Professional | | $1,110.39 | $1,721.58 | $2,775.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.90 / $1,909.00 / $6,679.00
| Facility | | $965.90 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.36 / $1,342.60 / $1,834.96
| Professional | | $1,108.36 | $1,342.60 | $1,834.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.63 / $2,388.06 / $3,150.23
| Professional | | $1,204.63 | $2,388.06 | $3,150.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.09 / $328.09 / $328.09
| Professional | | $328.09 | $328.09 | $328.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $26,542.00
| Facility | | $2,324.00 | $5,097.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.92 / $2,031.07 / $8,915.04
| Professional | | $1,164.92 | $2,031.07 | $8,915.04 |
- 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
- $1,098.82 / $1,774.10 / $2,830.29
| Professional | | $1,098.82 | $1,774.10 | $2,830.29 |