- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.87 / $2,747.00 / $4,806.64
| Facility | | $1,611.87 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,501.90 / $1,739.48 / $2,459.17
| Professional | | $1,501.90 | $1,739.48 | $2,459.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $15,715.52
| Facility | | $55.00 | $2,854.00 | $15,715.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,746.07 / $3,328.49 / $12,305.76
| Professional | | $1,746.07 | $3,328.49 | $12,305.76 |
- 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
- $1,324.65 / $2,852.52 / $6,013.65
| Professional | | $1,324.65 | $2,852.52 | $6,013.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,687.85 / $6,679.00
| Facility | | $300.00 | $2,687.85 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,952.09 / $2,466.69 / $3,623.49
| Professional | | $1,952.09 | $2,466.69 | $3,623.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,155.32 / $4,220.12 / $5,220.28
| Professional | | $2,155.32 | $4,220.12 | $5,220.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $15,715.52
| Facility | | $55.00 | $2,446.00 | $15,715.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,884.14 / $3,436.64 / $12,305.76
| Professional | | $1,884.14 | $3,436.64 | $12,305.76 |
- 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
- $1,826.55 / $2,546.81 / $5,636.38
| Professional | | $1,826.55 | $2,546.81 | $5,636.38 |