- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,900.52 / $5,796.00 / $11,880.00
| Facility | | $1,900.52 | $5,796.00 | $11,880.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.39 / $1,700.99 / $1,909.44
| Professional | | $1,068.39 | $1,700.99 | $1,909.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $7,578.00 / $14,193.00
| Facility | | $4,568.00 | $7,578.00 | $14,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,799.73 / $4,547.55 / $8,601.31
| Professional | | $3,799.73 | $4,547.55 | $8,601.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,783.88 / $1,783.88 / $7,227.90
| Facility | | $1,783.88 | $1,783.88 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,017.53 / $7,017.53 / $7,017.53
| Professional | | $7,017.53 | $7,017.53 | $7,017.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.01 / $2,017.01 / $2,017.01
| Professional | | $2,017.01 | $2,017.01 | $2,017.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.57 / $1,854.90 / $3,162.98
| Professional | | $1,281.57 | $1,854.90 | $3,162.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,783.88 / $7,227.90
| Facility | | $555.00 | $1,783.88 | $7,227.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,017.53 / $7,017.53 / $7,017.53
| Professional | | $7,017.53 | $7,017.53 | $7,017.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.00 / $6,762.00 / $16,403.00
| Facility | | $2,444.00 | $6,762.00 | $16,403.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.01 / $2,077.92 / $5,045.99
| Professional | | $1,426.01 | $2,077.92 | $5,045.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.26 / $1,613.26 / $1,613.26
| Facility | | $1,613.26 | $1,613.26 | $1,613.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.57 / $1,947.64 / $3,324.58
| Professional | | $1,281.57 | $1,947.64 | $3,324.58 |