- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,618.00 / $3,111.85 / $8,271.00
| Facility | | $2,618.00 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.28 / $1,649.97 / $2,290.66
| Professional | | $1,417.28 | $1,649.97 | $2,290.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.75 / $5,268.00 / $10,264.20
| Facility | | $1,707.75 | $5,268.00 | $10,264.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.66 / $2,066.92 / $10,894.88
| Professional | | $1,302.66 | $2,066.92 | $10,894.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.68 / $1,351.68 / $2,160.52
| Professional | | $1,351.68 | $1,351.68 | $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
- $1,398.26 / $2,689.60 / $4,615.01
| Professional | | $1,398.26 | $2,689.60 | $4,615.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.32 / $2,440.65 / $7,315.92
| Facility | | $1,498.32 | $2,440.65 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.64 / $2,074.55 / $2,863.70
| Professional | | $1,655.64 | $2,074.55 | $2,863.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,834.60 / $3,694.88 / $6,292.69
| Professional | | $1,834.60 | $3,694.88 | $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
- $1,454.37 / $2,108.94 / $10,894.88
| Professional | | $1,454.37 | $2,108.94 | $10,894.88 |
- 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
- $1,422.94 / $1,966.22 / $4,346.24
| Professional | | $1,422.94 | $1,966.22 | $4,346.24 |