- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.36 / $2,747.00 / $4,806.64
| Facility | | $1,071.36 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,038.18 / $1,231.60 / $1,924.58
| Professional | | $1,038.18 | $1,231.60 | $1,924.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,747.93 / $11,274.56
| Facility | | $55.00 | $2,747.93 | $11,274.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.08 / $2,319.83 / $8,823.12
| Professional | | $1,143.08 | $2,319.83 | $8,823.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.06 / $2,382.87 / $3,227.97
| Professional | | $1,453.06 | $2,382.87 | $3,227.97 |
- 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
- $804.83 / $2,013.92 / $4,302.82
| Professional | | $804.83 | $2,013.92 | $4,302.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,939.83 / $6,679.00
| Facility | | $300.00 | $1,939.83 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.83 / $1,788.41 / $2,615.09
| Professional | | $1,408.83 | $1,788.41 | $2,615.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.92 / $3,017.12 / $3,878.50
| Professional | | $1,540.92 | $3,017.12 | $3,878.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,274.56
| Facility | | $55.00 | $2,446.00 | $11,274.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.45 / $2,407.12 / $8,823.12
| Professional | | $1,265.45 | $2,407.12 | $8,823.12 |
- 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
- $1,151.11 / $1,761.98 / $3,981.52
| Professional | | $1,151.11 | $1,761.98 | $3,981.52 |