- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.09 / $1,029.09 / $3,599.20
| Facility | | $1,029.09 | $1,029.09 | $3,599.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.09 / $1,451.31 / $3,423.66
| Professional | | $1,029.09 | $1,451.31 | $3,423.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,414.00 / $7,231.00
| Facility | | $789.00 | $3,414.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.33 / $2,457.57 / $9,621.44
| Professional | | $1,402.33 | $2,457.57 | $9,621.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.07 / $2,569.26 / $4,429.37
| Professional | | $1,866.07 | $2,569.26 | $4,429.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,487.02 / $2,674.76 / $4,932.09
| Professional | | $1,487.02 | $2,674.76 | $4,932.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,113.12 / $8,090.00
| Facility | | $300.00 | $2,113.12 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.25 / $1,534.69 / $2,474.23
| Professional | | $824.25 | $1,534.69 | $2,474.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.03 / $3,386.00 / $4,299.10
| Professional | | $1,708.03 | $3,386.00 | $4,299.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.05 / $2,082.05 / $2,248.60
| Professional | | $2,082.05 | $2,082.05 | $2,248.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $10,354.87
| Facility | | $55.00 | $2,854.00 | $10,354.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.05 / $2,569.60 / $9,621.44
| Professional | | $1,467.05 | $2,569.60 | $9,621.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.36 / $1,963.52 / $3,753.91
| Professional | | $1,445.36 | $1,963.52 | $3,753.91 |