- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.11 / $4,771.00 / $9,539.00
| Facility | | $1,561.11 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.28 / $1,436.27 / $1,842.56
| Professional | | $1,249.28 | $1,436.27 | $1,842.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,142.00 / $37,782.72 / $52,623.67
| Facility | | $7,142.00 | $37,782.72 | $52,623.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,281.24 / $1,638.42 / $2,708.79
| Professional | | $1,281.24 | $1,638.42 | $2,708.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,633.04 / $1,633.04 / $17,559.00
| Professional | | $1,633.04 | $1,633.04 | $17,559.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,568.44
| Facility | | $640.00 | $640.00 | $1,568.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.99 / $1,748.94 / $3,043.40
| Professional | | $1,350.99 | $1,748.94 | $3,043.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.04 / $1,687.09 / $1,984.31
| Professional | | $1,318.04 | $1,687.09 | $1,984.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.55 / $1,824.14 / $2,688.84
| Facility | | $1,435.55 | $1,824.14 | $2,688.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.00 / $1,949.00 / $2,686.00
| Professional | | $1,732.00 | $1,949.00 | $2,686.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.34 / $1,727.35 / $5,924.94
| Facility | | $1,323.34 | $1,727.35 | $5,924.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.34 / $1,727.35 / $5,924.94
| Professional | | $1,323.34 | $1,727.35 | $5,924.94 |
- 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
- $1,070.08 / $1,646.27 / $2,657.41
| Professional | | $1,070.08 | $1,646.27 | $2,657.41 |