- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.66 / $2,747.00 / $4,806.64
| Facility | | $1,276.66 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,164.90 / $1,334.17 / $1,993.66
| Professional | | $1,164.90 | $1,334.17 | $1,993.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,045.44
| Facility | | $55.00 | $2,854.00 | $12,045.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.74 / $2,524.79 / $9,431.20
| Professional | | $1,333.74 | $2,524.79 | $9,431.20 |
- 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
- $1,075.13 / $2,188.44 / $4,605.01
| Professional | | $1,075.13 | $2,188.44 | $4,605.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,060.48 / $6,679.00
| Facility | | $300.00 | $2,060.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.45 / $1,890.95 / $2,777.73
| Professional | | $1,496.45 | $1,890.95 | $2,777.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.92 / $3,234.46 / $3,996.68
| Professional | | $1,651.92 | $3,234.46 | $3,996.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,045.44
| Facility | | $55.00 | $2,446.00 | $12,045.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.78 / $2,633.04 / $9,431.20
| Professional | | $1,414.78 | $2,633.04 | $9,431.20 |
- 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
- $1,404.45 / $1,949.16 / $4,523.97
| Professional | | $1,404.45 | $1,949.16 | $4,523.97 |