- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.71 / $2,747.00 / $4,806.64
| Facility | | $1,185.71 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.82 / $1,236.01 / $1,949.55
| Professional | | $1,094.82 | $1,236.01 | $1,949.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,796.08 / $10,049.76
| Facility | | $55.00 | $2,796.08 | $10,049.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.16 / $2,412.44 / $8,991.84
| Professional | | $1,200.16 | $2,412.44 | $8,991.84 |
- 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
- $944.09 / $2,083.57 / $4,391.05
| Professional | | $944.09 | $2,083.57 | $4,391.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,967.64 / $6,679.00
| Facility | | $506.00 | $1,967.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.03 / $1,805.74 / $2,652.57
| Professional | | $1,429.03 | $1,805.74 | $2,652.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,573.68 / $3,081.27 / $3,960.95
| Professional | | $1,573.68 | $3,081.27 | $3,960.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.17 / $1,793.17 / $1,793.17
| Professional | | $1,793.17 | $1,793.17 | $1,793.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $10,049.76
| Facility | | $55.00 | $2,446.00 | $10,049.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.51 / $2,500.61 / $8,991.84
| Professional | | $1,333.51 | $2,500.61 | $8,991.84 |
- 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
- $1,237.38 / $1,794.79 / $4,000.99
| Professional | | $1,237.38 | $1,794.79 | $4,000.99 |