- 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
- $965.88 / $1,072.45 / $1,538.81
| Professional | | $965.88 | $1,072.45 | $1,538.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $9,039.00
| Facility | | $1,313.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.37 / $1,379.85 / $7,129.92
| Professional | | $860.37 | $1,379.85 | $7,129.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $1,392.16
| Professional | | $974.02 | $974.02 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.85 / $1,757.38 / $3,143.60
| Professional | | $912.85 | $1,757.38 | $3,143.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.02 / $1,909.00 / $6,679.00
| Facility | | $979.02 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.82 / $1,353.73 / $1,868.68
| Professional | | $1,081.82 | $1,353.73 | $1,868.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.72 / $2,392.71 / $3,983.07
| Professional | | $1,199.72 | $2,392.71 | $3,983.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $26,542.00
| Facility | | $1,685.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.51 / $1,401.88 / $7,129.92
| Professional | | $958.51 | $1,401.88 | $7,129.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.89 / $1,312.72 / $2,913.17
| Professional | | $944.89 | $1,312.72 | $2,913.17 |