- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.49 / $2,747.00 / $4,806.64
| Facility | | $1,521.49 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.09 / $1,601.98 / $2,392.92
| Professional | | $1,462.09 | $1,601.98 | $2,392.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $28,002.08
| Facility | | $55.00 | $2,854.00 | $28,002.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,643.10 / $3,110.10 / $12,696.87
| Professional | | $1,643.10 | $3,110.10 | $12,696.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,756.20 / $2,879.99 / $3,901.40
| Professional | | $1,756.20 | $2,879.99 | $3,901.40 |
- 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
- $1,480.03 / $2,645.24 / $5,346.27
| Professional | | $1,480.03 | $2,645.24 | $5,346.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,383.26 / $6,679.00
| Facility | | $300.00 | $2,383.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.88 / $2,187.17 / $3,496.14
| Professional | | $1,730.88 | $2,187.17 | $3,496.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,923.07 / $3,765.37 / $4,669.26
| Professional | | $1,923.07 | $3,765.37 | $4,669.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $28,002.08
| Facility | | $55.00 | $2,446.00 | $28,002.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.46 / $3,139.03 / $12,696.87
| Professional | | $1,768.46 | $3,139.03 | $12,696.87 |
- 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
- $1,707.27 / $2,440.65 / $5,375.57
| Professional | | $1,707.27 | $2,440.65 | $5,375.57 |