- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.19 / $2,747.00 / $4,806.64
| Facility | | $1,318.19 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.15 / $1,385.79 / $2,041.67
| Professional | | $1,207.15 | $1,385.79 | $2,041.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,435.28
| Facility | | $55.00 | $2,854.00 | $12,435.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.80 / $2,605.96 / $9,845.53
| Professional | | $1,360.80 | $2,605.96 | $9,845.53 |
- 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
- $1,110.47 / $2,257.96 / $4,752.92
| Professional | | $1,110.47 | $2,257.96 | $4,752.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,126.87 / $6,679.00
| Facility | | $300.00 | $2,126.87 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.67 / $1,951.87 / $2,867.24
| Professional | | $1,544.67 | $1,951.87 | $2,867.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,705.57 / $3,339.51 / $4,127.21
| Professional | | $1,705.57 | $3,339.51 | $4,127.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,435.28
| Facility | | $55.00 | $2,446.00 | $12,435.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.34 / $2,718.62 / $9,845.53
| Professional | | $1,470.34 | $2,718.62 | $9,845.53 |
- 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
- $1,422.85 / $2,013.98 / $4,362.04
| Professional | | $1,422.85 | $2,013.98 | $4,362.04 |