- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.03 / $2,747.00 / $4,806.64
| Facility | | $1,060.03 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.87 / $1,110.16 / $1,650.12
| Professional | | $964.87 | $1,110.16 | $1,650.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,582.46 / $11,298.33
| Facility | | $55.00 | $2,582.46 | $11,298.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.19 / $2,107.17 / $7,863.68
| Professional | | $1,084.19 | $2,107.17 | $7,863.68 |
- 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
- $915.10 / $1,806.94 / $3,842.68
| Professional | | $915.10 | $1,806.94 | $3,842.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,745.33 / $6,679.00
| Facility | | $300.00 | $1,745.33 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,247.92 / $1,576.89 / $2,316.40
| Professional | | $1,247.92 | $1,576.89 | $2,316.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.08 / $2,696.32 / $3,333.07
| Professional | | $1,377.08 | $2,696.32 | $3,333.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,653.06 / $2,653.06 / $2,653.06
| Professional | | $2,653.06 | $2,653.06 | $2,653.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,298.33
| Facility | | $55.00 | $2,446.00 | $11,298.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.06 / $2,178.87 / $7,863.68
| Professional | | $1,174.06 | $2,178.87 | $7,863.68 |
- 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
- $1,131.47 / $1,628.61 / $4,050.16
| Professional | | $1,131.47 | $1,628.61 | $4,050.16 |