- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.15 / $2,747.00 / $4,806.64
| Facility | | $1,014.15 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.16 / $1,058.17 / $1,550.79
| Professional | | $920.16 | $1,058.17 | $1,550.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,472.26 / $9,574.48
| Facility | | $55.00 | $2,472.26 | $9,574.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.73 / $2,022.26 / $7,495.28
| Professional | | $1,063.73 | $2,022.26 | $7,495.28 |
- 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
- $863.06 / $1,741.37 / $3,674.34
| Professional | | $863.06 | $1,741.37 | $3,674.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,909.00 / $6,679.00
| Facility | | $578.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.35 / $1,506.68 / $2,213.26
| Professional | | $1,192.35 | $1,506.68 | $2,213.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,311.13 / $2,567.19 / $3,176.62
| Professional | | $1,311.13 | $2,567.19 | $3,176.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $9,574.48
| Facility | | $55.00 | $2,446.00 | $9,574.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,143.00 / $2,087.00 / $7,495.28
| Professional | | $1,143.00 | $2,087.00 | $7,495.28 |
- 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
- $1,082.70 / $1,565.97 / $3,340.43
| Professional | | $1,082.70 | $1,565.97 | $3,340.43 |