- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.95 / $5,412.00 / $11,425.00
| Facility | | $1,235.95 | $5,412.00 | $11,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.28 / $1,148.11 / $1,562.09
| Professional | | $1,010.28 | $1,148.11 | $1,562.09 |
- 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
- $1,024.01 / $1,309.48 / $2,164.96
| Professional | | $1,024.01 | $1,309.48 | $2,164.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,268.73 / $1,310.57 / $15,704.00
| Professional | | $1,268.73 | $1,310.57 | $15,704.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,249.94
| Facility | | $640.00 | $640.00 | $1,249.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.81 / $1,404.50 / $2,416.92
| Professional | | $1,080.81 | $1,404.50 | $2,416.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.45 / $1,349.70 / $1,590.32
| Professional | | $1,054.45 | $1,349.70 | $1,590.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.25 / $1,446.06 / $2,081.33
| Facility | | $1,136.25 | $1,446.06 | $2,081.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.00 / $1,556.00 / $2,145.00
| Professional | | $1,379.00 | $1,556.00 | $2,145.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.29 / $1,402.64 / $4,704.97
| Facility | | $1,058.29 | $1,402.64 | $4,704.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.29 / $1,402.64 / $4,704.97
| Professional | | $1,058.29 | $1,402.64 | $4,704.97 |
- 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
- $850.23 / $1,310.40 / $2,058.05
| Professional | | $850.23 | $1,310.40 | $2,058.05 |