- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,049.28 / $2,747.00 / $4,806.64
| Facility | | $1,049.28 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.78 / $1,097.00 / $1,627.49
| Professional | | $940.78 | $1,097.00 | $1,627.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,550.98 / $9,915.04
| Facility | | $55.00 | $2,550.98 | $9,915.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.70 / $2,081.00 / $7,763.76
| Professional | | $1,067.70 | $2,081.00 | $7,763.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.75 / $2,066.55 / $2,799.47
| Professional | | $1,393.75 | $2,066.55 | $2,799.47 |
- 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
- $888.73 / $1,804.10 / $3,794.60
| Professional | | $888.73 | $1,804.10 | $3,794.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,723.34 / $6,679.00
| Facility | | $300.00 | $1,723.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.08 / $1,556.89 / $2,287.02
| Professional | | $1,232.08 | $1,556.89 | $2,287.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.46 / $2,661.82 / $3,291.21
| Professional | | $1,359.46 | $2,661.82 | $3,291.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $9,915.04
| Facility | | $55.00 | $2,446.00 | $9,915.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.09 / $2,155.05 / $7,763.76
| Professional | | $1,161.09 | $2,155.05 | $7,763.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.46 / $1,608.86 / $3,704.85
| Professional | | $1,115.46 | $1,608.86 | $3,704.85 |