- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.88 / $5,412.00 / $11,425.00
| Facility | | $1,732.88 | $5,412.00 | $11,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.89 / $1,595.49 / $2,185.96
| Professional | | $1,331.89 | $1,595.49 | $2,185.96 |
- 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
- $1,399.61 / $1,812.52 / $3,019.65
| Professional | | $1,399.61 | $1,812.52 | $3,019.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.53 / $1,807.95 / $9,951.00
| Professional | | $1,768.53 | $1,807.95 | $9,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,736.58
| Facility | | $640.00 | $640.00 | $1,736.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.73 / $1,827.85 / $3,378.77
| Professional | | $1,186.73 | $1,827.85 | $3,378.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.69 / $1,867.12 / $2,194.73
| Professional | | $1,458.69 | $1,867.12 | $2,194.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.50 / $1,836.85 / $2,845.01
| Facility | | $1,317.50 | $1,836.85 | $2,845.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,382.00 / $2,024.00 / $2,990.00
| Professional | | $1,382.00 | $2,024.00 | $2,990.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.43 / $1,896.31 / $6,576.55
| Facility | | $1,095.43 | $1,896.31 | $6,576.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.43 / $1,896.31 / $6,576.55
| Professional | | $1,095.43 | $1,896.31 | $6,576.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,024.00 / $26,537.00
| Facility | | $7,408.00 | $13,024.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $959.45 / $1,570.87 / $2,860.55
| Professional | | $959.45 | $1,570.87 | $2,860.55 |