- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.33 / $2,747.00 / $5,454.00
| Facility | | $1,186.33 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.69 / $1,252.63 / $2,077.53
| Professional | | $1,148.69 | $1,252.63 | $2,077.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,595.82 / $9,401.00
| Facility | | $818.35 | $3,595.82 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.40 / $2,280.78 / $10,441.96
| Professional | | $1,128.40 | $2,280.78 | $10,441.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.41 / $2,303.46 / $4,207.89
| Professional | | $1,323.41 | $2,303.46 | $4,207.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.86 / $1,909.00 / $6,679.00
| Facility | | $1,133.86 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.80 / $1,301.11 / $2,097.66
| Professional | | $698.80 | $1,301.11 | $2,097.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.58 / $2,806.25 / $3,563.01
| Professional | | $1,415.58 | $2,806.25 | $3,563.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,901.23 / $5,901.23 / $5,901.23
| Facility | | $5,901.23 | $5,901.23 | $5,901.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $10,496.96
| Facility | | $55.00 | $5,268.00 | $10,496.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.53 / $2,412.78 / $10,441.96
| Professional | | $1,320.53 | $2,412.78 | $10,441.96 |
- 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
- $1,200.48 / $1,773.41 / $4,210.34
| Professional | | $1,200.48 | $1,773.41 | $4,210.34 |