- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.62 / $2,747.00 / $4,806.64
| Facility | | $1,017.62 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $905.71 / $1,054.10 / $1,571.54
| Professional | | $905.71 | $1,054.10 | $1,571.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,447.13 / $8,301.29
| Facility | | $55.00 | $2,447.13 | $8,301.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.58 / $1,962.36 / $7,531.04
| Professional | | $1,014.58 | $1,962.36 | $7,531.04 |
- 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
- $822.83 / $1,735.04 / $3,631.92
| Professional | | $822.83 | $1,735.04 | $3,631.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,659.59 / $6,679.00
| Facility | | $300.00 | $1,659.59 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,182.53 / $1,494.27 / $2,195.03
| Professional | | $1,182.53 | $1,494.27 | $2,195.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.05 / $2,510.25 / $3,103.88
| Professional | | $1,282.05 | $2,510.25 | $3,103.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $8,301.29
| Facility | | $55.00 | $2,446.00 | $8,301.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,072.03 / $1,999.30 / $7,531.04
| Professional | | $1,072.03 | $1,999.30 | $7,531.04 |
- 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
- $1,027.95 / $1,482.83 / $3,325.30
| Professional | | $1,027.95 | $1,482.83 | $3,325.30 |