- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.18 / $2,663.12 / $4,410.00
| Facility | | $1,110.18 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.13 / $1,110.18 / $2,163.11
| Professional | | $861.13 | $1,110.18 | $2,163.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $4,525.00 / $15,093.22
| Facility | | $1,313.00 | $4,525.00 | $15,093.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.63 / $2,166.48 / $8,629.20
| Professional | | $947.63 | $2,166.48 | $8,629.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.79 / $1,333.53 / $2,353.16
| Facility | | $1,025.79 | $1,333.53 | $2,353.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.82 / $2,137.14 / $3,728.92
| Professional | | $1,244.82 | $2,137.14 | $3,728.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.86 / $1,870.42 / $6,679.00
| Facility | | $867.86 | $1,870.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.42 / $1,745.58 / $2,594.04
| Professional | | $1,381.42 | $1,745.58 | $2,594.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.36 / $2,376.57 / $3,290.94
| Professional | | $1,108.36 | $2,376.57 | $3,290.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $5,098.00 / $26,542.00
| Facility | | $1,902.00 | $5,098.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.07 / $3,303.93 / $8,629.20
| Professional | | $1,380.07 | $3,303.93 | $8,629.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.09 / $1,840.74 / $4,475.43
| Professional | | $1,230.09 | $1,840.74 | $4,475.43 |