- 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
- $1,212.54 / $1,434.96 / $2,044.15
| Professional | | $1,212.54 | $1,434.96 | $2,044.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $11,409.35
| Facility | | $1,672.00 | $5,268.00 | $11,409.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.50 / $1,807.04 / $10,548.90
| Professional | | $1,166.50 | $1,807.04 | $10,548.90 |
- 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
- $2,639.52 / $2,639.52 / $2,639.52
| Facility | | $2,639.52 | $2,639.52 | $2,639.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,209.54 / $2,333.31 / $3,971.46
| Professional | | $1,209.54 | $2,333.31 | $3,971.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.65 / $2,170.65 / $6,679.00
| Facility | | $1,327.65 | $2,170.65 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.05 / $1,845.05 / $2,546.90
| Professional | | $1,467.05 | $1,845.05 | $2,546.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.61 / $3,265.92 / $6,292.69
| Professional | | $1,621.61 | $3,265.92 | $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
- $1,269.66 / $1,815.47 / $10,548.90
| Professional | | $1,269.66 | $1,815.47 | $10,548.90 |
- 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
- $1,244.48 / $1,720.78 / $3,872.34
| Professional | | $1,244.48 | $1,720.78 | $3,872.34 |