- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.69 / $2,747.00 / $5,454.00
| Facility | | $1,150.69 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.58 / $1,236.58 / $1,841.94
| Professional | | $1,146.58 | $1,236.58 | $1,841.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,764.00 / $7,619.68
| Facility | | $941.10 | $3,764.00 | $7,619.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,213.69 / $2,282.23 / $10,305.39
| Professional | | $1,213.69 | $2,282.23 | $10,305.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,341.39 / $2,199.61 / $3,588.22
| Professional | | $1,341.39 | $2,199.61 | $3,588.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.35 / $2,357.48 / $4,347.06
| Professional | | $1,340.35 | $2,357.48 | $4,347.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,834.41 / $8,090.00
| Facility | | $300.00 | $1,834.41 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.31 / $1,313.23 / $2,117.19
| Professional | | $705.31 | $1,313.23 | $2,117.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.60 / $2,859.17 / $3,810.51
| Professional | | $1,433.60 | $2,859.17 | $3,810.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,997.00 / $9,496.40
| Facility | | $55.00 | $3,997.00 | $9,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.40 / $2,445.88 / $10,305.39
| Professional | | $1,326.40 | $2,445.88 | $10,305.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.06 / $1,816.97 / $4,960.64
| Professional | | $1,311.06 | $1,816.97 | $4,960.64 |