- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.33 / $2,747.00 / $4,806.64
| Facility | | $1,075.33 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.86 / $1,120.23 / $1,611.43
| Professional | | $987.86 | $1,120.23 | $1,611.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,585.59 / $8,759.17
| Facility | | $55.00 | $2,585.59 | $8,759.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.57 / $2,111.17 / $9,419.54
| Professional | | $1,145.57 | $2,111.17 | $9,419.54 |
- 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
- $862.22 / $1,856.42 / $3,842.25
| Professional | | $862.22 | $1,856.42 | $3,842.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,744.26 / $6,679.00
| Facility | | $300.00 | $1,744.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.83 / $1,574.27 / $2,369.36
| Professional | | $1,245.83 | $1,574.27 | $2,369.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.32 / $2,649.80 / $3,282.23
| Professional | | $1,353.32 | $2,649.80 | $3,282.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $8,759.17
| Facility | | $55.00 | $2,446.00 | $8,759.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.21 / $2,126.94 / $9,419.54
| Professional | | $1,225.21 | $2,126.94 | $9,419.54 |
- 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
- $1,134.95 / $1,719.32 / $3,602.95
| Professional | | $1,134.95 | $1,719.32 | $3,602.95 |