- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,894.76 / $6,107.00
| Facility | | $2,528.00 | $2,894.76 | $6,107.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.72 / $1,414.21 / $2,261.21
| Professional | | $1,212.72 | $1,414.21 | $2,261.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.21 / $3,435.75 / $8,498.00
| Facility | | $1,613.21 | $3,435.75 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,378.00 / $2,382.81 / $10,279.20
| Professional | | $1,378.00 | $2,382.81 | $10,279.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.52 / $2,221.55 / $4,073.15
| Professional | | $1,449.52 | $2,221.55 | $4,073.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.15 / $2,318.94 / $6,679.00
| Facility | | $1,427.15 | $2,318.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,637.65 / $1,983.74 / $2,720.89
| Professional | | $1,637.65 | $1,983.74 | $2,720.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.98 / $3,347.68 / $4,418.27
| Professional | | $1,773.98 | $3,347.68 | $4,418.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.41 / $0.41 / $0.41
| Facility | | $0.41 | $0.41 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,913.60 / $11,913.60 / $11,913.60
| Professional | | $11,913.60 | $11,913.60 | $11,913.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,672.00 / $26,542.00
| Facility | | $1,640.00 | $3,672.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.73 / $2,639.79 / $10,279.20
| Professional | | $1,471.73 | $2,639.79 | $10,279.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.97 / $2,105.69 / $4,332.74
| Professional | | $1,313.97 | $2,105.69 | $4,332.74 |