- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.15 / $2,747.00 / $4,806.64
| Facility | | $1,586.15 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.33 / $1,644.51 / $2,448.41
| Professional | | $1,417.33 | $1,644.51 | $2,448.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,068.37
| Facility | | $55.00 | $2,854.00 | $13,068.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.61 / $3,142.30 / $11,692.40
| Professional | | $1,618.61 | $3,142.30 | $11,692.40 |
- 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
- $1,266.73 / $2,717.81 / $5,718.73
| Professional | | $1,266.73 | $2,717.81 | $5,718.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $2,433.23 / $6,679.00
| Facility | | $506.00 | $2,433.23 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,858.33 / $2,348.21 / $3,449.45
| Professional | | $1,858.33 | $2,348.21 | $3,449.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.36 / $4,006.77 / $5,150.68
| Professional | | $2,046.36 | $4,006.77 | $5,150.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,068.37
| Facility | | $55.00 | $2,446.00 | $13,068.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.13 / $3,269.32 / $11,692.40
| Professional | | $1,743.13 | $3,269.32 | $11,692.40 |
- 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
- $1,696.33 / $2,336.10 / $5,633.91
| Professional | | $1,696.33 | $2,336.10 | $5,633.91 |