- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.07 / $2,747.00 / $4,806.64
| Facility | | $1,631.07 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.19 / $1,703.78 / $2,522.57
| Professional | | $1,495.19 | $1,703.78 | $2,522.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $15,364.64
| Facility | | $55.00 | $2,854.00 | $15,364.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,700.99 / $3,215.28 / $12,031.92
| Professional | | $1,700.99 | $3,215.28 | $12,031.92 |
- 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
- $1,372.29 / $2,796.85 / $5,873.86
| Professional | | $1,372.29 | $2,796.85 | $5,873.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,625.69 / $6,679.00
| Facility | | $300.00 | $2,625.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.95 / $2,409.65 / $3,539.70
| Professional | | $1,906.95 | $2,409.65 | $3,539.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,108.21 / $4,127.88 / $5,105.70
| Professional | | $2,108.21 | $4,127.88 | $5,105.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $15,364.64
| Facility | | $55.00 | $2,446.00 | $15,364.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,816.66 / $3,370.94 / $12,031.92
| Professional | | $1,816.66 | $3,370.94 | $12,031.92 |
- 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
- $1,793.48 / $2,504.78 / $5,782.62
| Professional | | $1,793.48 | $2,504.78 | $5,782.62 |