- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.55 / $2,747.00 / $5,454.00
| Facility | | $1,432.55 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.30 / $1,700.62 / $3,679.42
| Professional | | $1,425.30 | $1,700.62 | $3,679.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $4,287.00 / $10,228.79
| Facility | | $818.35 | $4,287.00 | $10,228.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.23 / $2,735.76 / $12,628.99
| Professional | | $1,357.23 | $2,735.76 | $12,628.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.98 / $2,778.05 / $5,075.16
| Professional | | $1,594.98 | $2,778.05 | $5,075.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,160.23 / $8,090.00
| Facility | | $300.00 | $2,160.23 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.63 / $1,568.91 / $2,529.39
| Professional | | $842.63 | $1,568.91 | $2,529.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,707.62 / $3,385.19 / $4,298.08
| Professional | | $1,707.62 | $3,385.19 | $4,298.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.82 / $420.82 / $445.21
| Professional | | $420.82 | $420.82 | $445.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $11,272.00
| Facility | | $55.00 | $5,268.00 | $11,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.45 / $2,907.90 / $12,628.99
| Professional | | $1,585.45 | $2,907.90 | $12,628.99 |
- 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
- $1,357.23 / $2,047.22 / $5,219.80
| Professional | | $1,357.23 | $2,047.22 | $5,219.80 |