- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.06 / $2,747.00 / $4,806.64
| Facility | | $1,454.06 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.01 / $1,485.77 / $2,249.42
| Professional | | $1,401.01 | $1,485.77 | $2,249.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $17,283.50
| Facility | | $55.00 | $2,733.00 | $17,283.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,509.55 / $2,666.75 / $10,054.71
| Professional | | $1,509.55 | $2,666.75 | $10,054.71 |
- 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
- $1,239.35 / $2,481.96 / $4,900.20
| Professional | | $1,239.35 | $2,481.96 | $4,900.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,185.46 / $6,679.00
| Facility | | $300.00 | $2,185.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.23 / $2,005.65 / $3,263.82
| Professional | | $1,587.23 | $2,005.65 | $3,263.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,759.23 / $3,444.57 / $4,268.70
| Professional | | $1,759.23 | $3,444.57 | $4,268.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,831.33
| Facility | | $55.00 | $2,446.00 | $20,831.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.21 / $2,827.98 / $10,054.71
| Professional | | $1,616.21 | $2,827.98 | $10,054.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.39 / $2,361.31 / $5,241.21
| Professional | | $1,555.39 | $2,361.31 | $5,241.21 |