- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.84 / $2,747.00 / $4,806.64
| Facility | | $1,424.84 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.14 / $1,524.43 / $2,118.30
| Professional | | $1,310.14 | $1,524.43 | $2,118.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,125.12
| Facility | | $55.00 | $2,854.00 | $12,125.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.49 / $2,873.74 / $10,848.56
| Professional | | $1,453.49 | $2,873.74 | $10,848.56 |
- 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
- $1,111.99 / $2,513.82 / $5,309.43
| Professional | | $1,111.99 | $2,513.82 | $5,309.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,375.15 / $6,679.00
| Facility | | $300.00 | $2,375.15 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,724.99 / $2,179.73 / $3,201.94
| Professional | | $1,724.99 | $2,179.73 | $3,201.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,898.09 / $3,716.46 / $4,777.49
| Professional | | $1,898.09 | $3,716.46 | $4,777.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,125.12
| Facility | | $55.00 | $2,446.00 | $12,125.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.65 / $3,029.66 / $10,848.56
| Professional | | $1,614.65 | $3,029.66 | $10,848.56 |
- 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
- $1,535.56 / $2,254.30 / $5,224.97
| Professional | | $1,535.56 | $2,254.30 | $5,224.97 |