- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $5,691.00 / $26,450.00
| Facility | | $1,760.00 | $5,691.00 | $26,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.10 / $1,895.46 / $2,671.28
| Professional | | $1,669.10 | $1,895.46 | $2,671.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.00 / $10,500.00 / $32,783.00
| Facility | | $2,340.00 | $10,500.00 | $32,783.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,633.44 / $2,131.17 / $3,438.53
| Professional | | $1,633.44 | $2,131.17 | $3,438.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,371.00 / $24,415.00 / $29,229.00
| Facility | | $4,371.00 | $24,415.00 | $29,229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,586.27 / $2,383.58 / $3,977.99
| Professional | | $1,586.27 | $2,383.58 | $3,977.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.55 / $2,346.12 / $5,207.59
| Facility | | $1,598.55 | $2,346.12 | $5,207.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,766.86 / $3,260.48 / $13,253.41
| Professional | | $1,766.86 | $3,260.48 | $13,253.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $12,661.00
| Facility | | $1,189.00 | $3,300.00 | $12,661.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,711.73 / $2,456.03 / $4,298.38
| Professional | | $1,711.73 | $2,456.03 | $4,298.38 |