- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.31 / $4,771.00 / $9,539.00
| Facility | | $1,577.31 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.97 / $1,577.31 / $1,930.19
| Professional | | $1,325.97 | $1,577.31 | $1,930.19 |
- 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
- $1,288.60 / $1,647.85 / $2,329.40
| Professional | | $1,288.60 | $1,647.85 | $2,329.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.67 / $1,554.18 / $3,002.36
| Professional | | $1,539.67 | $1,554.18 | $3,002.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,592.05
| Facility | | $490.00 | $610.00 | $1,592.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.13 / $1,707.51 / $3,028.39
| Professional | | $1,197.13 | $1,707.51 | $3,028.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.29 / $1,595.12 / $2,296.65
| Professional | | $1,291.29 | $1,595.12 | $2,296.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.00 / $1,802.71 / $2,665.65
| Facility | | $1,432.00 | $1,802.71 | $2,665.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.00 / $1,946.00 / $3,219.77
| Professional | | $1,649.00 | $1,946.00 | $3,219.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.87 / $1,693.71 / $3,088.72
| Facility | | $1,334.87 | $1,693.71 | $3,088.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,334.87 / $1,693.71 / $3,088.72
| Professional | | $1,334.87 | $1,693.71 | $3,088.72 |
- 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
- $1,080.55 / $1,602.59 / $2,788.79
| Professional | | $1,080.55 | $1,602.59 | $2,788.79 |