- 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
- $1,484.61 / $1,721.76 / $2,387.48
| Professional | | $1,484.61 | $1,721.76 | $2,387.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.90 / $5,381.16 / $10,713.90
| Facility | | $1,780.90 | $5,381.16 | $10,713.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.85 / $2,160.38 / $11,376.48
| Professional | | $1,358.85 | $2,160.38 | $11,376.48 |
- 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
- $1,458.21 / $2,804.30 / $4,831.63
| Professional | | $1,458.21 | $2,804.30 | $4,831.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.28 / $2,544.73 / $7,315.92
| Facility | | $1,563.28 | $2,544.73 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.42 / $2,163.02 / $2,985.82
| Professional | | $1,727.42 | $2,163.02 | $2,985.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.88 / $3,856.57 / $6,292.69
| Professional | | $1,914.88 | $3,856.57 | $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
- $1,514.01 / $2,205.77 / $11,376.48
| Professional | | $1,514.01 | $2,205.77 | $11,376.48 |
- 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
- $1,489.88 / $2,168.94 / $4,859.97
| Professional | | $1,489.88 | $2,168.94 | $4,859.97 |