- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,308.54 / $5,048.00 / $10,767.00
| Facility | | $1,308.54 | $5,048.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.98 / $1,308.54 / $1,359.20
| Professional | | $988.98 | $1,308.54 | $1,359.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,524.00 / $22,312.00 / $37,718.00
| Facility | | $12,524.00 | $22,312.00 | $37,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.64 / $1,452.97 / $2,024.07
| Professional | | $1,136.64 | $1,452.97 | $2,024.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $1,404.20
| Facility | | $490.00 | $610.00 | $1,404.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.10 / $1,109.10 / $1,109.10
| Professional | | $1,109.10 | $1,109.10 | $1,109.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.27 / $1,413.72 / $2,019.60
| Professional | | $1,160.27 | $1,413.72 | $2,019.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.66 / $1,345.84 / $2,211.42
| Facility | | $951.66 | $1,345.84 | $2,211.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.54 / $1,863.00 / $2,850.77
| Professional | | $1,073.54 | $1,863.00 | $2,850.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.08 / $1,437.26 / $2,595.38
| Facility | | $1,109.08 | $1,437.26 | $2,595.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.08 / $1,437.26 / $2,595.38
| Professional | | $1,109.08 | $1,437.26 | $2,595.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.20 / $1,404.25 / $2,150.86
| Professional | | $912.20 | $1,404.25 | $2,150.86 |