- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $3,363.00 / $7,822.16
| Facility | | $2,575.00 | $3,363.00 | $7,822.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.54 / $2,017.51 / $11,142.34
| Professional | | $773.54 | $2,017.51 | $11,142.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.67 / $7,292.00 / $26,542.00
| Facility | | $1,772.67 | $7,292.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.85 / $9,143.20 / $38,986.00
| Professional | | $957.85 | $9,143.20 | $38,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.79 / $1,150.23 / $2,260.64
| Facility | | $884.79 | $1,150.23 | $2,260.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.03 / $883.03 / $883.03
| Professional | | $883.03 | $883.03 | $883.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.99 / $3,963.11 / $20,590.95
| Professional | | $1,090.99 | $3,963.11 | $20,590.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.28 / $1,613.32 / $6,679.00
| Facility | | $756.28 | $1,613.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,427.69 / $6,145.70 / $9,454.92
| Professional | | $3,427.69 | $6,145.70 | $9,454.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.05 / $6,677.71 / $14,825.18
| Professional | | $966.05 | $6,677.71 | $14,825.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $9,939.76 / $26,542.00
| Facility | | $2,485.00 | $9,939.76 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.95 / $17,739.18 / $38,986.00
| Professional | | $1,603.95 | $17,739.18 | $38,986.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $7,292.00 / $28,500.86
| Facility | | $2,485.00 | $7,292.00 | $28,500.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.60 / $10,364.94 / $20,815.68
| Professional | | $1,360.60 | $10,364.94 | $20,815.68 |