- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,171.98 / $2,747.00 / $5,454.00
| Facility | | $1,171.98 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.94 / $1,211.17 / $3,125.15
| Professional | | $1,169.94 | $1,211.17 | $3,125.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,819.78 / $10,026.09
| Facility | | $818.35 | $3,819.78 | $10,026.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,203.31 / $2,286.81 / $10,250.39
| Professional | | $1,203.31 | $2,286.81 | $10,250.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.33 / $2,365.58 / $4,361.97
| Professional | | $1,396.33 | $2,365.58 | $4,361.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,909.00 / $8,090.00
| Facility | | $300.00 | $1,909.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.55 / $1,363.94 / $2,198.94
| Professional | | $732.55 | $1,363.94 | $2,198.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,485.21 / $2,944.28 / $3,738.27
| Professional | | $1,485.21 | $2,944.28 | $3,738.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.33 / $389.33 / $389.33
| Professional | | $389.33 | $389.33 | $389.33 |
- 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
- $1,330.64 / $2,508.40 / $10,250.39
| Professional | | $1,330.64 | $2,508.40 | $10,250.39 |
- 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
- $1,315.25 / $1,736.56 / $4,091.58
| Professional | | $1,315.25 | $1,736.56 | $4,091.58 |