- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.00 / $6,107.00
| Facility | | $2,528.00 | $2,894.00 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.55 / $978.51 / $1,533.68
| Professional | | $865.55 | $978.51 | $1,533.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.03 / $4,498.70 / $14,547.21
| Facility | | $1,062.03 | $4,498.70 | $14,547.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.02 / $1,629.71 / $6,945.68
| Professional | | $982.02 | $1,629.71 | $6,945.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.46 / $1,870.40 / $2,830.87
| Professional | | $1,261.46 | $1,870.40 | $2,830.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.32 / $1,579.97 / $2,742.71
| Professional | | $986.32 | $1,579.97 | $2,742.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,559.78 / $8,090.00
| Facility | | $300.00 | $1,559.78 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.33 / $1,337.71 / $1,830.14
| Professional | | $1,104.33 | $1,337.71 | $1,830.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.31 / $2,269.21 / $2,987.00
| Professional | | $1,199.31 | $2,269.21 | $2,987.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.01 / $1,769.80 / $6,945.68
| Professional | | $1,046.01 | $1,769.80 | $6,945.68 |
- 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
- $1,042.08 / $1,569.53 / $3,148.63
| Professional | | $1,042.08 | $1,569.53 | $3,148.63 |