- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.60 / $2,747.00 / $4,806.64
| Facility | | $1,281.60 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.03 / $1,354.21 / $1,999.92
| Professional | | $1,274.03 | $1,354.21 | $1,999.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $15,906.28
| Facility | | $55.00 | $2,733.00 | $15,906.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.91 / $2,456.26 / $9,250.16
| Professional | | $1,387.91 | $2,456.26 | $9,250.16 |
- 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
- $1,206.00 / $2,266.03 / $4,507.93
| Professional | | $1,206.00 | $2,266.03 | $4,507.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,009.71 / $6,679.00
| Facility | | $300.00 | $2,009.71 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.59 / $1,844.36 / $2,980.87
| Professional | | $1,459.59 | $1,844.36 | $2,980.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.74 / $3,169.49 / $3,929.91
| Professional | | $1,618.74 | $3,169.49 | $3,929.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,163.56
| Facility | | $55.00 | $2,446.00 | $19,163.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.64 / $2,582.85 / $9,250.16
| Professional | | $1,488.64 | $2,582.85 | $9,250.16 |
- 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
- $1,459.01 / $2,165.40 / $4,827.51
| Professional | | $1,459.01 | $2,165.40 | $4,827.51 |