- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.16 / $2,747.00 / $4,806.64
| Facility | | $1,031.16 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.90 / $1,101.13 / $1,654.10
| Professional | | $977.90 | $1,101.13 | $1,654.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,447.31 / $8,355.41
| Facility | | $55.00 | $2,447.31 | $8,355.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.96 / $2,000.75 / $7,486.96
| Professional | | $1,080.96 | $2,000.75 | $7,486.96 |
- 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
- $854.94 / $1,772.20 / $3,646.71
| Professional | | $854.94 | $1,772.20 | $3,646.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,656.98 / $6,679.00
| Facility | | $300.00 | $1,656.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.88 / $1,498.50 / $2,248.89
| Professional | | $1,185.88 | $1,498.50 | $2,248.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.26 / $2,561.57 / $3,166.64
| Professional | | $1,308.26 | $2,561.57 | $3,166.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $8,355.41
| Facility | | $55.00 | $2,446.00 | $8,355.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.55 / $2,083.79 / $7,486.96
| Professional | | $1,163.55 | $2,083.79 | $7,486.96 |
- 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
- $1,107.76 / $1,635.25 / $4,306.53
| Professional | | $1,107.76 | $1,635.25 | $4,306.53 |