- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,259.31 / $2,663.12 / $4,410.00
| Facility | | $1,259.31 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.87 / $1,259.31 / $2,385.69
| Professional | | $729.87 | $1,259.31 | $2,385.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $4,983.00 / $7,385.01
| Facility | | $941.10 | $4,983.00 | $7,385.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.97 / $2,166.39 / $6,262.16
| Professional | | $1,005.97 | $2,166.39 | $6,262.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.08 / $1,397.60 / $2,466.23
| Facility | | $1,075.08 | $1,397.60 | $2,466.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,043.85 / $1,872.43 / $3,791.24
| Professional | | $1,043.85 | $1,872.43 | $3,791.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.75 / $1,909.00 / $7,315.92
| Facility | | $909.75 | $1,909.00 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,557.81 / $1,968.96 / $2,717.93
| Professional | | $1,557.81 | $1,968.96 | $2,717.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.34 / $2,380.25 / $4,135.89
| Professional | | $1,124.34 | $2,380.25 | $4,135.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,572.00 / $9,401.00
| Facility | | $55.00 | $5,572.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.86 / $2,542.27 / $10,124.95
| Professional | | $1,713.86 | $2,542.27 | $10,124.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,550.05 / $2,207.44 / $3,875.52
| Professional | | $1,550.05 | $2,207.44 | $3,875.52 |