- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,712.00
| Facility | | $1,758.00 | $2,747.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.97 / $1,296.65 / $2,250.11
| Professional | | $1,149.97 | $1,296.65 | $2,250.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.00 / $5,987.00 / $25,526.57
| Facility | | $2,089.00 | $5,987.00 | $25,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.25 / $2,168.13 / $9,256.00
| Professional | | $1,260.25 | $2,168.13 | $9,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,309.48 / $2,130.01 / $3,679.88
| Professional | | $1,309.48 | $2,130.01 | $3,679.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.34 / $2,068.56 / $7,315.92
| Facility | | $1,278.34 | $2,068.56 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.91 / $1,776.91 / $2,427.11
| Professional | | $1,466.91 | $1,776.91 | $2,427.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,595.39 / $3,162.70 / $4,172.10
| Professional | | $1,595.39 | $3,162.70 | $4,172.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,332.43 / $4,332.43 / $4,332.43
| Facility | | $4,332.43 | $4,332.43 | $4,332.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,151.87 / $2,151.87 / $2,151.87
| Professional | | $2,151.87 | $2,151.87 | $2,151.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,078.00 / $33,500.00
| Facility | | $2,386.00 | $6,078.00 | $33,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.82 / $2,346.52 / $9,256.00
| Professional | | $1,396.82 | $2,346.52 | $9,256.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.13 / $1,930.66 / $3,973.48
| Professional | | $1,333.13 | $1,930.66 | $3,973.48 |