- 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
- $898.07 / $1,046.00 / $2,862.81
| Professional | | $898.07 | $1,046.00 | $2,862.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,647.12 / $4,916.00 / $15,169.65
| Facility | | $1,647.12 | $4,916.00 | $15,169.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.55 / $1,708.74 / $7,240.32
| Professional | | $966.55 | $1,708.74 | $7,240.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.88 / $1,977.50 / $6,576.18
| Professional | | $1,939.88 | $1,977.50 | $6,576.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.58 / $1,648.53 / $2,756.19
| Professional | | $1,097.58 | $1,648.53 | $2,756.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.90 / $1,811.48 / $6,679.00
| Facility | | $1,001.90 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.68 / $1,392.64 / $1,898.23
| Professional | | $1,149.68 | $1,392.64 | $1,898.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,255.42 / $2,488.73 / $3,934.05
| Professional | | $1,255.42 | $2,488.73 | $3,934.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.72 / $1,587.72 / $1,587.72
| Professional | | $1,587.72 | $1,587.72 | $1,587.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $16,394.00
| Facility | | $2,324.00 | $5,097.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.90 / $1,836.97 / $7,240.32
| Professional | | $1,054.90 | $1,836.97 | $7,240.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.51 / $1,552.08 / $3,013.44
| Professional | | $1,047.51 | $1,552.08 | $3,013.44 |