- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.80 / $4,761.00 / $8,451.00
| Facility | | $1,347.80 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.23 / $1,268.16 / $1,652.27
| Professional | | $1,147.23 | $1,268.16 | $1,652.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $7,463.00 / $11,048.00
| Facility | | $2,800.00 | $7,463.00 | $11,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,233.80 / $1,280.35 / $1,280.35
| Professional | | $1,233.80 | $1,280.35 | $1,280.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,149.08 / $1,571.35 / $2,538.82
| Professional | | $1,149.08 | $1,571.35 | $2,538.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.71 / $1,952.41 / $1,969.45
| Professional | | $1,471.71 | $1,952.41 | $1,969.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $5,342.00 / $9,617.00
| Facility | | $1,151.00 | $5,342.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.23 / $1,347.80 / $5,958.00
| Professional | | $1,147.23 | $1,347.80 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,452.70 / $3,258.90
| Professional | | $6.00 | $1,452.70 | $3,258.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,199.36 / $1,607.83 / $2,592.91
| Professional | | $1,199.36 | $1,607.83 | $2,592.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.76 / $1,225.36 / $1,225.36
| Facility | | $1,216.76 | $1,225.36 | $1,225.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.42 / $1,225.36 / $1,302.33
| Professional | | $1,195.42 | $1,225.36 | $1,302.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.79 / $1,497.34 / $2,487.19
| Professional | | $1,070.79 | $1,497.34 | $2,487.19 |