- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.75 / $5,412.00 / $14,187.00
| Facility | | $1,522.75 | $5,412.00 | $14,187.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,483.47 / $1,522.75 / $2,059.54
| Professional | | $1,483.47 | $1,522.75 | $2,059.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.73 / $1,192.95 / $1,686.56
| Professional | | $940.73 | $1,192.95 | $1,686.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.00 / $897.00 / $1,591.53
| Professional | | $778.00 | $897.00 | $1,591.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,702.97 / $9,243.56 / $11,400.40
| Professional | | $7,702.97 | $9,243.56 | $11,400.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.47 / $1,961.31 / $3,089.31
| Facility | | $1,483.47 | $1,961.31 | $3,089.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.06 / $7,498.08 / $11,169.00
| Professional | | $899.06 | $7,498.08 | $11,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,554.68 / $2,580.50 / $9,628.35
| Facility | | $1,554.68 | $2,580.50 | $9,628.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.68 / $2,580.50 / $9,628.35
| Professional | | $1,554.68 | $2,580.50 | $9,628.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.89 / $1,444.21 / $3,065.63
| Professional | | $947.89 | $1,444.21 | $3,065.63 |