- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.32 / $2,747.00 / $4,806.64
| Facility | | $1,335.32 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.11 / $1,404.73 / $2,066.46
| Professional | | $1,246.11 | $1,404.73 | $2,066.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,590.24
| Facility | | $55.00 | $2,854.00 | $12,590.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.08 / $2,637.58 / $9,857.60
| Professional | | $1,389.08 | $2,637.58 | $9,857.60 |
- 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
- $1,124.09 / $2,287.34 / $4,812.82
| Professional | | $1,124.09 | $2,287.34 | $4,812.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,153.26 / $6,679.00
| Facility | | $300.00 | $2,153.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.84 / $1,976.09 / $2,902.81
| Professional | | $1,563.84 | $1,976.09 | $2,902.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,726.87 / $3,381.21 / $4,178.02
| Professional | | $1,726.87 | $3,381.21 | $4,178.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,590.24
| Facility | | $55.00 | $2,446.00 | $12,590.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.75 / $2,753.64 / $9,857.60
| Professional | | $1,470.75 | $2,753.64 | $9,857.60 |
- 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
- $1,444.18 / $2,036.72 / $5,250.78
| Professional | | $1,444.18 | $2,036.72 | $5,250.78 |