- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.04 / $2,747.00 / $5,011.00
| Facility | | $1,202.04 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.10 / $1,269.81 / $1,847.39
| Professional | | $1,119.10 | $1,269.81 | $1,847.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.78 / $6,474.00 / $22,189.40
| Facility | | $1,383.78 | $6,474.00 | $22,189.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,248.45 / $2,414.03 / $8,894.00
| Professional | | $1,248.45 | $2,414.03 | $8,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.43 / $2,072.17 / $4,343.10
| Professional | | $997.43 | $2,072.17 | $4,343.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,974.36 / $6,679.00
| Facility | | $814.00 | $1,974.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,411.59 / $1,783.70 / $2,620.19
| Professional | | $1,411.59 | $1,783.70 | $2,620.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.71 / $3,074.92 / $3,879.63
| Professional | | $1,557.71 | $3,074.92 | $3,879.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $7,454.00 / $22,189.40
| Facility | | $1,804.00 | $7,454.00 | $22,189.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.73 / $2,478.67 / $8,894.00
| Professional | | $1,358.73 | $2,478.67 | $8,894.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $6,003.00 / $13,647.00
| Facility | | $1,804.00 | $6,003.00 | $13,647.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.27 / $1,882.56 / $3,976.15
| Professional | | $1,322.27 | $1,882.56 | $3,976.15 |