- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.10 / $2,747.00 / $4,806.64
| Facility | | $1,318.10 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.70 / $1,372.27 / $2,047.01
| Professional | | $1,192.70 | $1,372.27 | $2,047.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,429.20
| Facility | | $55.00 | $2,854.00 | $12,429.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,372.76 / $2,612.42 / $9,730.24
| Professional | | $1,372.76 | $2,612.42 | $9,730.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.70 / $2,601.90 / $3,513.75
| Professional | | $1,581.70 | $2,601.90 | $3,513.75 |
- 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
- $1,101.00 / $2,244.42 / $4,759.89
| Professional | | $1,101.00 | $2,244.42 | $4,759.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $2,163.05 / $6,679.00
| Facility | | $714.00 | $2,163.05 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,545.27 / $1,952.63 / $2,868.34
| Professional | | $1,545.27 | $1,952.63 | $2,868.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,703.94 / $3,336.31 / $4,125.21
| Professional | | $1,703.94 | $3,336.31 | $4,125.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.23 / $309.23 / $309.23
| Professional | | $309.23 | $309.23 | $309.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,429.20
| Facility | | $55.00 | $2,446.00 | $12,429.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.55 / $2,690.47 / $9,730.24
| Professional | | $1,451.55 | $2,690.47 | $9,730.24 |
- 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
- $1,435.64 / $2,111.34 / $5,623.14
| Professional | | $1,435.64 | $2,111.34 | $5,623.14 |