- 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
- $1,402.42 / $1,707.61 / $2,223.19
| Professional | | $1,402.42 | $1,707.61 | $2,223.19 |
- 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
- $1,658.37 / $2,493.05 / $2,962.97
| Professional | | $1,658.37 | $2,493.05 | $2,962.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.55 / $2,148.33 / $3,414.72
| Professional | | $1,602.55 | $2,148.33 | $3,414.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.03 / $2,619.80 / $2,641.03
| Professional | | $1,975.03 | $2,619.80 | $2,641.03 |
- 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
- $1,402.42 / $1,741.09 / $5,958.00
| Professional | | $1,402.42 | $1,741.09 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $6.00 / $4,376.80
| Professional | | $6.00 | $6.00 | $4,376.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,613.09 / $2,166.94 / $3,666.85
| Professional | | $1,613.09 | $2,166.94 | $3,666.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,647.85 / $1,647.85 / $1,721.34
| Facility | | $1,647.85 | $1,647.85 | $1,721.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.77 / $1,647.85 / $1,749.58
| Professional | | $1,606.77 | $1,647.85 | $1,749.58 |
- 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
- $1,483.77 / $2,033.85 / $3,312.79
| Professional | | $1,483.77 | $2,033.85 | $3,312.79 |