- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.41 / $2,747.00 / $4,806.64
| Facility | | $1,252.41 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,134.81 / $1,307.38 / $1,925.97
| Professional | | $1,134.81 | $1,307.38 | $1,925.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,832.48
| Facility | | $55.00 | $2,854.00 | $11,832.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,293.27 / $2,479.69 / $9,263.28
| Professional | | $1,293.27 | $2,479.69 | $9,263.28 |
- 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
- $1,012.31 / $2,148.57 / $4,522.06
| Professional | | $1,012.31 | $2,148.57 | $4,522.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,024.15 / $6,679.00
| Facility | | $300.00 | $2,024.15 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.07 / $1,857.61 / $2,728.76
| Professional | | $1,470.07 | $1,857.61 | $2,728.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.84 / $3,177.33 / $3,924.93
| Professional | | $1,622.84 | $3,177.33 | $3,924.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,832.48
| Facility | | $55.00 | $2,446.00 | $11,832.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,379.71 / $2,583.73 / $9,263.28
| Professional | | $1,379.71 | $2,583.73 | $9,263.28 |
- 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
- $1,346.12 / $1,914.19 / $4,439.39
| Professional | | $1,346.12 | $1,914.19 | $4,439.39 |