- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.01 / $5,135.00 / $11,627.00
| Facility | | $1,866.01 | $5,135.00 | $11,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.32 / $1,257.40 / $2,313.21
| Professional | | $1,153.32 | $1,257.40 | $2,313.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.00 / $7,084.00 / $36,529.00
| Facility | | $1,267.00 | $7,084.00 | $36,529.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.77 / $1,343.69 / $2,212.42
| Professional | | $1,019.77 | $1,343.69 | $2,212.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.45 / $1,441.74 / $1,784.46
| Facility | | $1,201.45 | $1,441.74 | $1,784.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.26 / $1,321.60 / $1,561.89
| Professional | | $971.26 | $1,321.60 | $1,561.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $581.00 / $1,434.80
| Facility | | $425.00 | $581.00 | $1,434.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.27 / $1,657.77 / $2,534.29
| Professional | | $1,104.27 | $1,657.77 | $2,534.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $562.00 / $1,434.80
| Facility | | $425.00 | $562.00 | $1,434.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,104.27 / $1,682.03 / $2,526.78
| Professional | | $1,104.27 | $1,682.03 | $2,526.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.40 / $1,051.62 / $1,685.25
| Professional | | $112.40 | $1,051.62 | $1,685.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $9,154.00 / $14,485.00
| Facility | | $1,375.00 | $9,154.00 | $14,485.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.97 / $1,488.79 / $2,635.96
| Professional | | $1,061.97 | $1,488.79 | $2,635.96 |