- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.46 / $2,747.00 / $4,806.64
| Facility | | $1,058.46 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.86 / $1,090.33 / $1,626.32
| Professional | | $936.86 | $1,090.33 | $1,626.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,558.02 / $9,913.12
| Facility | | $55.00 | $2,558.02 | $9,913.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.61 / $2,090.69 / $7,759.68
| Professional | | $1,039.61 | $2,090.69 | $7,759.68 |
- 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
- $842.83 / $1,806.40 / $3,802.60
| Professional | | $842.83 | $1,806.40 | $3,802.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,731.47 / $6,679.00
| Facility | | $300.00 | $1,731.47 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.25 / $1,559.62 / $2,291.03
| Professional | | $1,234.25 | $1,559.62 | $2,291.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.82 / $2,658.61 / $3,286.22
| Professional | | $1,357.82 | $2,658.61 | $3,286.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $9,913.12
| Facility | | $55.00 | $2,446.00 | $9,913.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,155.23 / $2,168.06 / $7,759.68
| Professional | | $1,155.23 | $2,168.06 | $7,759.68 |
- 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
- $1,088.77 / $1,558.56 / $3,740.55
| Professional | | $1,088.77 | $1,558.56 | $3,740.55 |