- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.87 / $2,747.00 / $4,806.64
| Facility | | $1,453.87 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.00 / $1,560.74 / $2,202.33
| Professional | | $1,360.00 | $1,560.74 | $2,202.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,887.00 / $22,711.04
| Facility | | $55.00 | $3,887.00 | $22,711.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.20 / $2,870.66 / $10,728.24
| Professional | | $1,459.20 | $2,870.66 | $10,728.24 |
- 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
- $1,300.99 / $2,495.84 / $5,238.18
| Professional | | $1,300.99 | $2,495.84 | $5,238.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,342.51 / $6,679.00
| Facility | | $300.00 | $2,342.51 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,701.28 / $2,149.77 / $3,157.94
| Professional | | $1,701.28 | $2,149.77 | $3,157.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,879.65 / $3,680.35 / $4,549.68
| Professional | | $1,879.65 | $3,680.35 | $4,549.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $27,403.04
| Facility | | $55.00 | $5,097.00 | $27,403.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,604.42 / $3,000.04 / $10,728.24
| Professional | | $1,604.42 | $3,000.04 | $10,728.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $13,017.00
| Facility | | $1,697.00 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.35 / $2,354.28 / $5,135.87
| Professional | | $1,554.35 | $2,354.28 | $5,135.87 |