- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.54 / $4,771.00 / $9,539.00
| Facility | | $1,468.54 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.99 / $1,468.54 / $1,789.96
| Professional | | $1,225.99 | $1,468.54 | $1,789.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,807.00 / $17,284.09 / $24,194.30
| Facility | | $7,807.00 | $17,284.09 | $24,194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.58 / $1,524.84 / $2,171.69
| Professional | | $1,208.58 | $1,524.84 | $2,171.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.89 / $1,470.75 / $2,867.96
| Professional | | $1,436.89 | $1,470.75 | $2,867.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,474.51
| Facility | | $490.00 | $610.00 | $1,474.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.13 / $1,664.07 / $2,844.15
| Professional | | $1,238.13 | $1,664.07 | $2,844.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.10 / $1,472.60 / $2,214.08
| Professional | | $1,192.10 | $1,472.60 | $2,214.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.26 / $1,696.39 / $2,518.14
| Facility | | $1,336.26 | $1,696.39 | $2,518.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.00 / $1,839.01 / $2,982.62
| Professional | | $1,627.00 | $1,839.01 | $2,982.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.98 / $1,631.35 / $2,854.71
| Facility | | $1,301.98 | $1,631.35 | $2,854.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.98 / $1,631.35 / $2,854.71
| Professional | | $1,301.98 | $1,631.35 | $2,854.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.25 / $1,536.43 / $2,530.67
| Professional | | $1,024.25 | $1,536.43 | $2,530.67 |