- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.00 / $3,745.00 / $8,017.00
| Facility | | $1,068.00 | $3,745.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.14 / $1,102.45 / $1,776.65
| Professional | | $969.14 | $1,102.45 | $1,776.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.77 / $1,567.34 / $2,112.63
| Professional | | $1,006.77 | $1,567.34 | $2,112.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.30 / $1,453.63 / $2,369.38
| Professional | | $1,101.30 | $1,453.63 | $2,369.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.56 / $1,931.17 / $1,931.17
| Professional | | $1,427.56 | $1,931.17 | $1,931.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $3,839.00 / $8,017.00
| Facility | | $1,013.00 | $3,839.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.14 / $1,180.49 / $3,748.00
| Professional | | $969.14 | $1,180.49 | $3,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,237.40 / $2,846.60
| Professional | | $6.00 | $1,237.40 | $2,846.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.30 / $1,453.63 / $2,369.38
| Professional | | $1,101.30 | $1,453.63 | $2,369.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.43 / $1,109.32 / $1,109.32
| Facility | | $951.43 | $1,109.32 | $1,109.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.43 / $1,109.32 / $1,179.43
| Professional | | $951.43 | $1,109.32 | $1,179.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,824.00 / $4,789.00
| Facility | | $1,175.00 | $2,824.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,137.06 / $1,529.78 / $2,396.66
| Professional | | $1,137.06 | $1,529.78 | $2,396.66 |