- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,510.10 / $4,771.00 / $9,539.00
| Facility | | $1,510.10 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.42 / $1,510.10 / $1,840.64
| Professional | | $1,269.42 | $1,510.10 | $1,840.64 |
- 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
- $1,240.99 / $1,562.96 / $2,221.12
| Professional | | $1,240.99 | $1,562.96 | $2,221.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.85 / $1,512.64 / $2,949.65
| Professional | | $1,469.85 | $1,512.64 | $2,949.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,514.70
| Facility | | $490.00 | $610.00 | $1,514.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.70 / $1,690.33 / $2,870.17
| Professional | | $1,262.70 | $1,690.33 | $2,870.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.65 / $1,506.62 / $2,280.58
| Professional | | $1,219.65 | $1,506.62 | $2,280.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.32 / $1,745.36 / $2,553.75
| Facility | | $1,375.32 | $1,745.36 | $2,553.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.00 / $1,891.41 / $3,055.46
| Professional | | $1,676.00 | $1,891.41 | $3,055.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,337.27 / $1,664.06 / $2,934.54
| Facility | | $1,337.27 | $1,664.06 | $2,934.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,337.27 / $1,664.06 / $2,934.54
| Professional | | $1,337.27 | $1,664.06 | $2,934.54 |
- 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
- $1,066.88 / $1,570.72 / $2,590.19
| Professional | | $1,066.88 | $1,570.72 | $2,590.19 |