- 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
- $1,028.04 / $1,327.41 / $1,836.08
| Professional | | $1,028.04 | $1,327.41 | $1,836.08 |
- 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
- $1,050.51 / $1,634.80 / $8,803.44
| Professional | | $1,050.51 | $1,634.80 | $8,803.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $692.82 / $2,160.52
| Professional | | $692.82 | $692.82 | $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
- $1,044.29 / $2,170.36 / $3,694.28
| Professional | | $1,044.29 | $2,170.36 | $3,694.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,209.74 / $1,969.47 / $6,679.00
| Facility | | $1,209.74 | $1,969.47 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.76 / $1,674.05 / $2,310.84
| Professional | | $1,336.76 | $1,674.05 | $2,310.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.52 / $2,983.78 / $5,944.58
| Professional | | $1,481.52 | $2,983.78 | $5,944.58 |
- 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
- $1,140.50 / $1,677.12 / $8,803.44
| Professional | | $1,140.50 | $1,677.12 | $8,803.44 |
- 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
- $1,135.82 / $1,504.34 / $3,493.89
| Professional | | $1,135.82 | $1,504.34 | $3,493.89 |