- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.27 / $2,747.00 / $5,454.00
| Facility | | $1,520.27 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.63 / $1,070.72 / $2,230.14
| Professional | | $860.63 | $1,070.72 | $2,230.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.93 / $3,592.00 / $8,957.00
| Facility | | $1,176.93 | $3,592.00 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.70 / $1,733.74 / $7,573.76
| Professional | | $991.70 | $1,733.74 | $7,573.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.26 / $2,040.34 / $2,764.12
| Professional | | $1,244.26 | $2,040.34 | $2,764.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.19 / $1,630.11 / $2,997.53
| Professional | | $1,062.19 | $1,630.11 | $2,997.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.64 / $1,909.00 / $6,679.00
| Facility | | $1,049.64 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.46 / $1,459.00 / $1,996.51
| Professional | | $1,204.46 | $1,459.00 | $1,996.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,307.84 / $2,581.69 / $3,384.43
| Professional | | $1,307.84 | $2,581.69 | $3,384.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.00 / $1,552.00 / $1,552.00
| Professional | | $1,552.00 | $1,552.00 | $1,552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,672.00 / $26,542.00
| Facility | | $1,640.00 | $3,672.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.15 / $1,925.89 / $7,573.76
| Professional | | $1,055.15 | $1,925.89 | $7,573.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.05 / $1,575.67 / $3,257.33
| Professional | | $1,010.05 | $1,575.67 | $3,257.33 |