- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.23 / $2,747.00 / $4,806.64
| Facility | | $931.23 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.23 / $1,132.89 / $1,647.49
| Professional | | $931.23 | $1,132.89 | $1,647.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,687.71 / $10,481.84
| Facility | | $55.00 | $2,687.71 | $10,481.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,064.88 / $2,166.42 / $9,902.00
| Professional | | $1,064.88 | $2,166.42 | $9,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.39 / $1,907.44 / $4,003.09
| Professional | | $873.39 | $1,907.44 | $4,003.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,818.59 / $6,679.00
| Facility | | $300.00 | $1,818.59 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.58 / $1,644.71 / $2,416.02
| Professional | | $1,301.58 | $1,644.71 | $2,416.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,438.11 / $2,815.82 / $3,581.76
| Professional | | $1,438.11 | $2,815.82 | $3,581.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $10,481.84
| Facility | | $55.00 | $2,446.00 | $10,481.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.73 / $2,294.23 / $9,902.00
| Professional | | $1,197.73 | $2,294.23 | $9,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.38 / $1,641.23 / $3,524.12
| Professional | | $1,050.38 | $1,641.23 | $3,524.12 |