- 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
- $1,253.63 / $1,475.73 / $2,106.58
| Professional | | $1,253.63 | $1,475.73 | $2,106.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.34 / $1,851.76 / $11,139.99
| Professional | | $1,202.34 | $1,851.76 | $11,139.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.02 / $974.02 / $2,160.52
| Professional | | $974.02 | $974.02 | $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
- $1,250.32 / $2,404.46 / $4,104.66
| Professional | | $1,250.32 | $2,404.46 | $4,104.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.02 / $2,236.67 / $6,679.00
| Facility | | $1,368.02 | $2,236.67 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.66 / $1,901.17 / $2,624.35
| Professional | | $1,511.66 | $1,901.17 | $2,624.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.76 / $3,364.91 / $6,292.69
| Professional | | $1,670.76 | $3,364.91 | $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
- $1,285.91 / $1,874.27 / $11,139.99
| Professional | | $1,285.91 | $1,874.27 | $11,139.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.00 / $5,268.00 / $10,910.95
| Facility | | $2,175.00 | $5,268.00 | $10,910.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.71 / $1,738.24 / $3,991.47
| Professional | | $1,241.71 | $1,738.24 | $3,991.47 |