- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.00 / $2,747.00 / $4,806.64
| Facility | | $1,322.00 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.15 / $1,334.22 / $2,038.48
| Professional | | $1,166.15 | $1,334.22 | $2,038.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,773.44
| Facility | | $55.00 | $2,854.00 | $11,773.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.63 / $2,472.46 / $11,470.21
| Professional | | $1,292.63 | $2,472.46 | $11,470.21 |
- 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
- $1,007.41 / $2,196.08 / $4,497.47
| Professional | | $1,007.41 | $2,196.08 | $4,497.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,014.11 / $6,679.00
| Facility | | $300.00 | $2,014.11 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.78 / $1,848.39 / $2,715.22
| Professional | | $1,462.78 | $1,848.39 | $2,715.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.07 / $3,113.36 / $3,851.20
| Professional | | $1,590.07 | $3,113.36 | $3,851.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,773.44
| Facility | | $55.00 | $2,446.00 | $11,773.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,391.19 / $2,541.29 / $11,470.21
| Professional | | $1,391.19 | $2,541.29 | $11,470.21 |
- 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
- $1,349.39 / $1,994.27 / $5,321.44
| Professional | | $1,349.39 | $1,994.27 | $5,321.44 |