- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.00 / $4,761.00 / $8,451.00
| Facility | | $1,384.00 | $4,761.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.10 / $1,562.51 / $2,043.92
| Professional | | $1,265.10 | $1,562.51 | $2,043.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,532.53 / $2,275.94 / $2,695.93
| Professional | | $1,532.53 | $2,275.94 | $2,695.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.23 / $1,954.86 / $3,115.04
| Professional | | $1,458.23 | $1,954.86 | $3,115.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.68 / $2,415.17 / $2,428.40
| Professional | | $1,820.68 | $2,415.17 | $2,428.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,993.00 / $9,617.00
| Facility | | $1,020.00 | $4,993.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.47 / $1,593.15 / $5,958.00
| Professional | | $1,273.47 | $1,593.15 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $6.00 / $3,978.20
| Professional | | $6.00 | $6.00 | $3,978.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,484.44 / $1,977.67 / $3,335.58
| Professional | | $1,484.44 | $1,977.67 | $3,335.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.73 / $1,512.73 / $1,566.21
| Facility | | $1,512.73 | $1,512.73 | $1,566.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,473.01 / $1,513.41 / $1,602.30
| Professional | | $1,473.01 | $1,513.41 | $1,602.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.00 / $3,914.00 / $7,000.00
| Facility | | $2,332.00 | $3,914.00 | $7,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.18 / $1,869.78 / $3,014.52
| Professional | | $1,337.18 | $1,869.78 | $3,014.52 |