- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.00 / $2,663.12 / $3,693.00
| Facility | | $1,421.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.83 / $1,009.18 / $1,650.30
| Professional | | $829.83 | $1,009.18 | $1,650.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,630.26 / $9,039.00
| Facility | | $1,313.00 | $3,630.26 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.00 / $1,788.39 / $7,642.32
| Professional | | $926.00 | $1,788.39 | $7,642.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.58 / $1,735.51 / $2,988.02
| Professional | | $1,134.58 | $1,735.51 | $2,988.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.91 / $1,811.48 / $6,679.00
| Facility | | $1,081.91 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.49 / $1,503.85 / $2,056.10
| Professional | | $1,241.49 | $1,503.85 | $2,056.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.76 / $2,737.22 / $3,610.83
| Professional | | $1,380.76 | $2,737.22 | $3,610.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,525.00 / $16,394.00
| Facility | | $1,902.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,016.28 / $1,889.58 / $7,642.32
| Professional | | $1,016.28 | $1,889.58 | $7,642.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.91 / $1,590.16 / $4,205.70
| Professional | | $984.91 | $1,590.16 | $4,205.70 |