- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.53 / $2,618.00 / $3,625.00
| Facility | | $1,081.53 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.36 / $1,095.71 / $1,638.51
| Professional | | $942.36 | $1,095.71 | $1,638.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $4,983.00 / $16,394.00
| Facility | | $941.10 | $4,983.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,032.21 / $2,105.77 / $8,018.24
| Professional | | $1,032.21 | $2,105.77 | $8,018.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $1,695.28 / $1,695.28
| Professional | | $605.88 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,111.82
| Facility | | $593.00 | $652.29 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.67 / $1,790.77 / $3,860.35
| Professional | | $756.67 | $1,790.77 | $3,860.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,811.48 / $6,679.00
| Facility | | $506.00 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.53 / $1,589.04 / $2,334.25
| Professional | | $1,257.53 | $1,589.04 | $2,334.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.51 / $2,687.62 / $3,560.48
| Professional | | $1,361.51 | $2,687.62 | $3,560.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $6,111.42 / $16,394.00
| Facility | | $1,485.00 | $6,111.42 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.43 / $2,153.15 / $8,018.24
| Professional | | $1,140.43 | $2,153.15 | $8,018.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.64 / $1,563.95 / $3,734.43
| Professional | | $1,066.64 | $1,563.95 | $3,734.43 |