- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.58 / $1,443.88 / $2,000.77
| Professional | | $1,223.58 | $1,443.88 | $2,000.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.29 / $1,795.43 / $9,497.04
| Professional | | $1,152.29 | $1,795.43 | $9,497.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $2,160.52
| Professional | | $974.02 | $974.02 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.05 / $2,338.67 / $3,990.51
| Professional | | $1,221.05 | $2,338.67 | $3,990.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.64 / $2,132.37 / $6,679.00
| Facility | | $1,307.64 | $2,132.37 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,444.94 / $1,812.51 / $2,501.98
| Professional | | $1,444.94 | $1,812.51 | $2,501.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,599.90 / $3,222.20 / $6,292.69
| Professional | | $1,599.90 | $3,222.20 | $6,292.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.69 / $1,810.62 / $9,497.04
| Professional | | $1,250.69 | $1,810.62 | $9,497.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.30 / $1,642.07 / $3,902.38
| Professional | | $1,238.30 | $1,642.07 | $3,902.38 |