- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.00 / $2,894.76 / $6,107.00
| Facility | | $1,525.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.65 / $1,020.00 / $2,144.61
| Professional | | $834.65 | $1,020.00 | $2,144.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,877.33 / $5,904.00 / $17,998.22
| Facility | | $1,877.33 | $5,904.00 | $17,998.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.17 / $1,617.63 / $8,470.17
| Professional | | $902.17 | $1,617.63 | $8,470.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.24 / $1,593.31 / $2,599.16
| Professional | | $1,157.24 | $1,593.31 | $2,599.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.89 / $1,734.92 / $3,144.37
| Professional | | $970.89 | $1,734.92 | $3,144.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.95 / $1,771.70 / $6,679.00
| Facility | | $828.95 | $1,771.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.88 / $978.86 / $1,533.56
| Professional | | $510.88 | $978.86 | $1,533.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.33 / $2,070.87 / $3,035.28
| Professional | | $1,038.33 | $2,070.87 | $3,035.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $15,421.00
| Facility | | $2,386.00 | $6,883.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,048.90 / $1,660.99 / $8,470.17
| Professional | | $1,048.90 | $1,660.99 | $8,470.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,883.00 / $15,421.00
| Facility | | $2,386.00 | $6,883.00 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.58 / $1,308.03 / $2,812.71
| Professional | | $949.58 | $1,308.03 | $2,812.71 |