- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.94 / $2,747.00 / $5,039.00
| Facility | | $1,420.94 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.35 / $1,597.20 / $2,580.63
| Professional | | $1,400.35 | $1,597.20 | $2,580.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,903.16 / $10,078.32
| Facility | | $1,485.00 | $4,903.16 | $10,078.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.92 / $2,615.67 / $11,098.24
| Professional | | $1,556.92 | $2,615.67 | $11,098.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.54 / $2,483.04 / $4,431.79
| Professional | | $1,568.54 | $2,483.04 | $4,431.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,421.10 / $8,090.00
| Facility | | $300.00 | $2,421.10 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.36 / $2,129.94 / $2,901.99
| Professional | | $1,758.36 | $2,129.94 | $2,901.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.93 / $3,627.02 / $4,774.31
| Professional | | $1,916.93 | $3,627.02 | $4,774.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.77 / $304.77 / $304.77
| Facility | | $304.77 | $304.77 | $304.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.44 / $2,344.44 / $2,344.44
| Professional | | $2,344.44 | $2,344.44 | $2,344.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,983.00 / $11,272.00
| Facility | | $55.00 | $4,983.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.38 / $2,813.02 / $11,098.24
| Professional | | $1,695.38 | $2,813.02 | $11,098.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.39 / $2,308.40 / $4,546.66
| Professional | | $1,549.39 | $2,308.40 | $4,546.66 |