- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.11 / $1,176.70 / $1,685.44
| Professional | | $1,056.11 | $1,176.70 | $1,685.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.00 / $4,236.14 / $12,850.00
| Facility | | $1,939.00 | $4,236.14 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.83 / $1,515.05 / $7,838.16
| Professional | | $929.83 | $1,515.05 | $7,838.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $1,392.16
| Professional | | $692.82 | $692.82 | $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
- $1,001.13 / $1,928.25 / $3,444.31
| Professional | | $1,001.13 | $1,928.25 | $3,444.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.57 / $1,909.00 / $6,679.00
| Facility | | $1,074.57 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.40 / $1,483.72 / $2,048.11
| Professional | | $1,187.40 | $1,483.72 | $2,048.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.09 / $2,654.63 / $4,210.07
| Professional | | $1,318.09 | $2,654.63 | $4,210.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,280.00 / $26,542.00
| Facility | | $2,324.00 | $6,280.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.58 / $1,536.95 / $7,838.16
| Professional | | $1,053.58 | $1,536.95 | $7,838.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $10,764.00
| Facility | | $2,324.00 | $5,063.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.66 / $1,410.66 / $3,095.99
| Professional | | $1,042.66 | $1,410.66 | $3,095.99 |