- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.55 / $2,747.00 / $4,806.64
| Facility | | $1,289.55 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.49 / $1,356.22 / $1,994.71
| Professional | | $1,190.49 | $1,356.22 | $1,994.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $23,862.08
| Facility | | $55.00 | $2,854.00 | $23,862.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.21 / $2,509.39 / $9,355.76
| Professional | | $1,371.21 | $2,509.39 | $9,355.76 |
- 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
- $1,278.49 / $2,218.11 / $4,559.72
| Professional | | $1,278.49 | $2,218.11 | $4,559.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,063.16 / $6,679.00
| Facility | | $814.00 | $2,063.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.68 / $1,869.75 / $2,849.03
| Professional | | $1,479.68 | $1,869.75 | $2,849.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.94 / $3,203.17 / $3,962.79
| Professional | | $1,635.94 | $3,203.17 | $3,962.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $23,862.08
| Facility | | $55.00 | $2,446.00 | $23,862.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.17 / $2,617.62 / $9,355.76
| Professional | | $1,467.17 | $2,617.62 | $9,355.76 |
- 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
- $1,406.00 / $2,036.77 / $4,487.43
| Professional | | $1,406.00 | $2,036.77 | $4,487.43 |