- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.14 / $4,796.00 / $9,539.00
| Facility | | $1,659.14 | $4,796.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.25 / $1,659.14 / $2,020.03
| Professional | | $1,373.25 | $1,659.14 | $2,020.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,960.66 / $9,475.45 / $13,263.73
| Facility | | $5,960.66 | $9,475.45 | $13,263.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.26 / $1,709.55 / $2,416.61
| Professional | | $1,321.26 | $1,709.55 | $2,416.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.25 / $1,662.33 / $3,241.54
| Professional | | $1,603.25 | $1,662.33 | $3,241.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,661.76
| Facility | | $490.00 | $610.00 | $1,661.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.33 / $1,773.16 / $3,147.52
| Professional | | $1,226.33 | $1,773.16 | $3,147.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.86 / $1,641.54 / $2,492.88
| Professional | | $1,328.86 | $1,641.54 | $2,492.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.27 / $1,886.62 / $2,803.95
| Facility | | $1,410.27 | $1,886.62 | $2,803.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.00 / $2,091.00 / $3,338.88
| Professional | | $1,706.00 | $2,091.00 | $3,338.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.78 / $1,805.27 / $3,218.12
| Facility | | $1,292.78 | $1,805.27 | $3,218.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.78 / $1,805.27 / $3,218.12
| Professional | | $1,292.78 | $1,805.27 | $3,218.12 |
- 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
- $1,122.68 / $1,581.17 / $2,731.94
| Professional | | $1,122.68 | $1,581.17 | $2,731.94 |