- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.52 / $2,747.00 / $4,806.64
| Facility | | $1,456.52 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.70 / $1,527.03 / $2,243.79
| Professional | | $1,331.70 | $1,527.03 | $2,243.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,734.24
| Facility | | $55.00 | $2,854.00 | $13,734.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.72 / $2,875.82 / $10,754.00
| Professional | | $1,497.72 | $2,875.82 | $10,754.00 |
- 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
- $1,108.04 / $2,499.29 / $5,250.53
| Professional | | $1,108.04 | $2,499.29 | $5,250.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,348.01 / $6,679.00
| Facility | | $300.00 | $2,348.01 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,705.28 / $2,154.82 / $3,165.35
| Professional | | $1,705.28 | $2,154.82 | $3,165.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,884.16 / $3,689.19 / $4,560.64
| Professional | | $1,884.16 | $3,689.19 | $4,560.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,734.24
| Facility | | $55.00 | $2,446.00 | $13,734.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.09 / $3,006.68 / $10,754.00
| Professional | | $1,623.09 | $3,006.68 | $10,754.00 |
- 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
- $1,604.54 / $2,263.02 / $6,190.10
| Professional | | $1,604.54 | $2,263.02 | $6,190.10 |