- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,156.63 / $2,747.00 / $7,625.00
| Facility | | $1,156.63 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.67 / $1,615.70 / $3,595.38
| Professional | | $1,139.67 | $1,615.70 | $3,595.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,784.44 / $7,608.00
| Facility | | $941.10 | $3,784.44 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.08 / $2,276.91 / $8,300.40
| Professional | | $1,167.08 | $2,276.91 | $8,300.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,577.62 / $2,172.11 / $3,543.36
| Professional | | $1,577.62 | $2,172.11 | $3,543.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.59 / $2,358.23 / $4,286.17
| Professional | | $1,323.59 | $2,358.23 | $4,286.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,132.28 / $1,909.00 / $7,315.92
| Facility | | $1,132.28 | $1,909.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.82 / $1,299.29 / $2,094.71
| Professional | | $697.82 | $1,299.29 | $2,094.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,420.90 / $2,816.79 / $3,776.75
| Professional | | $1,420.90 | $2,816.79 | $3,776.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.72 / $1,822.76 / $3,460.29
| Professional | | $1,777.72 | $1,822.76 | $3,460.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $9,401.00
| Facility | | $55.00 | $5,268.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.02 / $2,415.32 / $8,300.40
| Professional | | $1,321.02 | $2,415.32 | $8,300.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.74 / $1,785.63 / $3,889.27
| Professional | | $1,305.74 | $1,785.63 | $3,889.27 |