- 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
- $992.62 / $1,094.49 / $1,579.04
| Professional | | $992.62 | $1,094.49 | $1,579.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.38 / $3,715.00 / $9,039.00
| Facility | | $1,110.38 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.30 / $1,369.05 / $7,111.92
| Professional | | $854.30 | $1,369.05 | $7,111.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,392.16
| Professional | | $605.88 | $605.88 | $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
- $911.01 / $1,751.74 / $3,202.35
| Professional | | $911.01 | $1,751.74 | $3,202.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.87 / $1,811.48 / $6,679.00
| Facility | | $976.87 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.44 / $1,351.17 / $1,865.14
| Professional | | $1,079.44 | $1,351.17 | $1,865.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,196.84 / $2,410.46 / $4,054.78
| Professional | | $1,196.84 | $2,410.46 | $4,054.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $16,394.00
| Facility | | $1,685.00 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.74 / $1,407.14 / $7,111.92
| Professional | | $957.74 | $1,407.14 | $7,111.92 |
- 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
- $909.95 / $1,273.25 / $2,800.47
| Professional | | $909.95 | $1,273.25 | $2,800.47 |