- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $2,747.00 / $5,039.00
| Facility | | $1,924.00 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,150.14 / $1,426.59 / $2,017.44
| Professional | | $1,150.14 | $1,426.59 | $2,017.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.00 / $5,268.00 / $10,138.40
| Facility | | $1,672.00 | $5,268.00 | $10,138.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.77 / $1,750.73 / $9,100.40
| Professional | | $1,103.77 | $1,750.73 | $9,100.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.84 / $855.84 / $2,160.52
| Professional | | $855.84 | $855.84 | $2,160.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.51 / $2,082.51 / $2,082.51
| Facility | | $2,082.51 | $2,082.51 | $2,082.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.50 / $2,265.34 / $3,864.37
| Professional | | $1,173.50 | $2,265.34 | $3,864.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,255.43 / $2,050.69 / $6,679.00
| Facility | | $1,255.43 | $2,050.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.25 / $1,743.09 / $2,406.15
| Professional | | $1,387.25 | $1,743.09 | $2,406.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.36 / $3,090.20 / $6,292.69
| Professional | | $1,534.36 | $3,090.20 | $6,292.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $6,104.00 / $26,542.00
| Facility | | $2,155.00 | $6,104.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,224.02 / $1,788.47 / $9,100.40
| Professional | | $1,224.02 | $1,788.47 | $9,100.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,402.00 / $8,810.00
| Facility | | $2,155.00 | $4,402.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.04 / $1,654.87 / $3,779.51
| Professional | | $1,221.04 | $1,654.87 | $3,779.51 |