- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.37 / $5,412.00 / $11,425.00
| Facility | | $1,704.37 | $5,412.00 | $11,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.60 / $1,557.96 / $2,144.37
| Professional | | $1,357.60 | $1,557.96 | $2,144.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,142.00 / $20,977.18 / $29,216.95
| Facility | | $7,142.00 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.42 / $1,778.33 / $2,940.11
| Professional | | $1,360.42 | $1,778.33 | $2,940.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.58 / $1,774.16 / $9,951.00
| Professional | | $1,735.58 | $1,774.16 | $9,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,703.48
| Facility | | $640.00 | $640.00 | $1,703.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.99 / $1,794.93 / $3,313.59
| Professional | | $1,094.99 | $1,794.93 | $3,313.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,431.28 / $1,832.04 / $2,153.57
| Professional | | $1,431.28 | $1,832.04 | $2,153.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.80 / $1,806.63 / $2,790.78
| Facility | | $1,200.80 | $1,806.63 | $2,790.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.00 / $1,986.00 / $2,935.00
| Professional | | $1,309.00 | $1,986.00 | $2,935.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.11 / $1,792.69 / $6,449.61
| Facility | | $1,004.11 | $1,792.69 | $6,449.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,004.11 / $1,792.69 / $6,449.61
| Professional | | $1,004.11 | $1,792.69 | $6,449.61 |
- 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
- $854.15 / $1,523.14 / $2,891.97
| Professional | | $854.15 | $1,523.14 | $2,891.97 |