- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.89 / $5,587.00 / $11,425.00
| Facility | | $1,093.89 | $5,587.00 | $11,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.05 / $1,093.89 / $1,395.28
| Professional | | $1,040.05 | $1,093.89 | $1,395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,976.00 / $37,782.72 / $52,623.67
| Facility | | $13,976.00 | $37,782.72 | $52,623.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.45 / $1,325.39 / $2,212.60
| Professional | | $1,036.45 | $1,325.39 | $2,212.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,876.00 / $17,559.00 / $22,492.00
| Professional | | $14,876.00 | $17,559.00 | $22,492.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,260.85
| Facility | | $640.00 | $640.00 | $1,260.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,251.05 / $5,251.05 / $5,251.05
| Professional | | $5,251.05 | $5,251.05 | $5,251.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.97 / $1,282.10 / $1,482.92
| Professional | | $1,001.97 | $1,282.10 | $1,482.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $999.68 / $1,192.33 / $1,949.14
| Facility | | $999.68 | $1,192.33 | $1,949.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.99 / $1,838.76 / $2,607.71
| Professional | | $1,449.99 | $1,838.76 | $2,607.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.76 / $1,420.51 / $4,632.60
| Facility | | $1,072.76 | $1,420.51 | $4,632.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.76 / $1,420.51 / $4,632.60
| Professional | | $1,072.76 | $1,420.51 | $4,632.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.23 / $1,602.33 / $2,523.60
| Professional | | $915.23 | $1,602.33 | $2,523.60 |