- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $2,955.00 / $7,203.00
| Facility | | $1,749.00 | $2,955.00 | $7,203.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.41 / $888.66 / $1,200.38
| Professional | | $733.41 | $888.66 | $1,200.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.14 / $4,113.10 / $11,879.05
| Facility | | $1,001.14 | $4,113.10 | $11,879.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.91 / $1,167.35 / $2,844.09
| Professional | | $767.91 | $1,167.35 | $2,844.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.74 / $1,738.91 / $2,498.27
| Professional | | $1,238.74 | $1,738.91 | $2,498.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.18 / $2,748.18 / $2,748.18
| Facility | | $2,748.18 | $2,748.18 | $2,748.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.43 / $1,567.36 / $2,864.49
| Professional | | $829.43 | $1,567.36 | $2,864.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,444.32 / $8,090.00
| Facility | | $300.00 | $1,444.32 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.69 / $1,228.68 / $1,694.67
| Professional | | $1,005.69 | $1,228.68 | $1,694.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.68 / $2,206.69 / $7,928.48
| Professional | | $1,095.68 | $2,206.69 | $7,928.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,916.00 / $12,850.00
| Facility | | $55.00 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.80 / $1,212.11 / $6,328.64
| Professional | | $865.80 | $1,212.11 | $6,328.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,063.00 / $10,764.00
| Facility | | $2,324.00 | $5,063.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.19 / $1,151.96 / $2,493.90
| Professional | | $806.19 | $1,151.96 | $2,493.90 |