- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.81 / $2,747.00 / $5,631.54
| Facility | | $1,060.81 | $2,747.00 | $5,631.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,044.39 / $1,139.48 / $2,513.55
| Professional | | $1,044.39 | $1,139.48 | $2,513.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,378.21 / $8,496.53
| Facility | | $818.35 | $3,378.21 | $8,496.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.98 / $2,097.42 / $7,695.28
| Professional | | $1,083.98 | $2,097.42 | $7,695.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.98 / $2,019.77 / $3,294.85
| Professional | | $1,466.98 | $2,019.77 | $3,294.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.76 / $2,161.96 / $3,986.54
| Professional | | $1,230.76 | $2,161.96 | $3,986.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,684.44 / $8,090.00
| Facility | | $300.00 | $1,684.44 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.85 / $1,206.24 / $1,944.70
| Professional | | $647.85 | $1,206.24 | $1,944.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.27 / $2,611.36 / $3,315.57
| Professional | | $1,317.27 | $2,611.36 | $3,315.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $9,401.00
| Facility | | $55.00 | $5,268.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.63 / $2,245.92 / $7,695.28
| Professional | | $1,218.63 | $2,245.92 | $7,695.28 |
- 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
- $1,192.83 / $1,587.09 / $3,549.34
| Professional | | $1,192.83 | $1,587.09 | $3,549.34 |