- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,515.64 / $2,747.00 / $4,806.64
| Facility | | $1,515.64 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.08 / $1,576.76 / $2,408.08
| Professional | | $1,403.08 | $1,576.76 | $2,408.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,976.00
| Facility | | $55.00 | $2,854.00 | $13,976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.05 / $2,926.84 / $11,136.64
| Professional | | $1,567.05 | $2,926.84 | $11,136.64 |
- 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
- $1,200.08 / $2,547.64 / $5,337.90
| Professional | | $1,200.08 | $2,547.64 | $5,337.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,386.92 / $6,679.00
| Facility | | $300.00 | $2,386.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,733.54 / $2,190.53 / $3,217.81
| Professional | | $1,733.54 | $2,190.53 | $3,217.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,888.26 / $3,697.21 / $4,574.62
| Professional | | $1,888.26 | $3,697.21 | $4,574.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,976.00
| Facility | | $55.00 | $2,446.00 | $13,976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.94 / $3,034.04 / $11,136.64
| Professional | | $1,660.94 | $3,034.04 | $11,136.64 |
- 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
- $1,611.21 / $2,262.94 / $5,222.18
| Professional | | $1,611.21 | $2,262.94 | $5,222.18 |