- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.00 / $5,360.00 / $9,347.59
| Facility | | $1,538.00 | $5,360.00 | $9,347.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.69 / $1,360.64 / $1,787.48
| Professional | | $1,136.69 | $1,360.64 | $1,787.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,178.52 / $1,540.56 / $2,547.00
| Professional | | $1,178.52 | $1,540.56 | $2,547.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.59 / $1,470.11 / $7,252.08
| Professional | | $1,370.59 | $1,470.11 | $7,252.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.00 / $776.00 / $1,466.37
| Facility | | $776.00 | $776.00 | $1,466.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.89 / $1,587.24 / $2,817.60
| Professional | | $1,239.89 | $1,587.24 | $2,817.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.45 / $1,585.22 / $1,872.83
| Professional | | $1,238.45 | $1,585.22 | $1,872.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.00 / $1,622.20 / $2,410.44
| Facility | | $1,241.00 | $1,622.20 | $2,410.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.00 / $1,785.84 / $2,440.00
| Professional | | $1,585.00 | $1,785.84 | $2,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.98 / $1,610.00 / $5,485.18
| Facility | | $1,185.98 | $1,610.00 | $5,485.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.98 / $1,610.00 / $5,485.18
| Professional | | $1,185.98 | $1,610.00 | $5,485.18 |
- 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
- $991.19 / $1,533.07 / $2,439.64
| Professional | | $991.19 | $1,533.07 | $2,439.64 |