- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.91 / $2,663.12 / $5,454.00
| Facility | | $1,547.91 | $2,663.12 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.17 / $1,101.48 / $2,763.64
| Professional | | $979.17 | $1,101.48 | $2,763.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $5,063.00 / $26,542.00
| Facility | | $1,591.00 | $5,063.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.04 / $2,097.51 / $11,430.60
| Professional | | $1,144.04 | $2,097.51 | $11,430.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.04 / $2,082.73 / $3,212.69
| Professional | | $1,270.04 | $2,082.73 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.94 / $1,755.36 / $3,362.37
| Professional | | $854.94 | $1,755.36 | $3,362.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,909.00 / $6,679.00
| Facility | | $814.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.18 / $1,563.15 / $2,336.34
| Professional | | $1,230.18 | $1,563.15 | $2,336.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.25 / $2,631.84 / $3,398.45
| Professional | | $1,333.25 | $2,631.84 | $3,398.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,993.70 / $26,542.00
| Facility | | $1,591.00 | $6,993.70 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.90 / $2,163.44 / $11,430.60
| Professional | | $1,192.90 | $2,163.44 | $11,430.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.95 / $1,674.86 / $4,090.38
| Professional | | $1,147.95 | $1,674.86 | $4,090.38 |