- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.13 / $2,747.00 / $4,806.64
| Facility | | $1,387.13 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.13 / $1,459.71 / $2,173.23
| Professional | | $1,312.13 | $1,459.71 | $2,173.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $25,656.96
| Facility | | $55.00 | $2,854.00 | $25,656.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,458.74 / $2,719.60 / $10,060.71
| Professional | | $1,458.74 | $2,719.60 | $10,060.71 |
- 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
- $1,140.57 / $2,380.60 / $4,903.04
| Professional | | $1,140.57 | $2,380.60 | $4,903.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,189.77 / $6,679.00
| Facility | | $300.00 | $2,189.77 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.35 / $2,009.60 / $3,042.51
| Professional | | $1,590.35 | $2,009.60 | $3,042.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,759.23 / $3,444.57 / $4,263.74
| Professional | | $1,759.23 | $3,444.57 | $4,263.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $25,656.96
| Facility | | $55.00 | $2,446.00 | $25,656.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,545.46 / $2,818.05 / $10,060.71
| Professional | | $1,545.46 | $2,818.05 | $10,060.71 |
- 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
- $1,506.38 / $2,307.78 / $4,848.14
| Professional | | $1,506.38 | $2,307.78 | $4,848.14 |