- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.56 / $2,747.00 / $4,806.64
| Facility | | $1,310.56 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.22 / $1,366.64 / $1,942.66
| Professional | | $1,185.22 | $1,366.64 | $1,942.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,304.40
| Facility | | $55.00 | $2,854.00 | $12,304.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.59 / $2,587.33 / $9,634.16
| Professional | | $1,361.59 | $2,587.33 | $9,634.16 |
- 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
- $1,100.72 / $2,239.86 / $4,715.12
| Professional | | $1,100.72 | $2,239.86 | $4,715.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,106.03 / $6,679.00
| Facility | | $300.00 | $2,106.03 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,529.54 / $1,932.75 / $2,839.14
| Professional | | $1,529.54 | $1,932.75 | $2,839.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,686.73 / $3,302.62 / $4,087.37
| Professional | | $1,686.73 | $3,302.62 | $4,087.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,304.40
| Facility | | $55.00 | $2,446.00 | $12,304.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.56 / $2,699.20 / $9,634.16
| Professional | | $1,442.56 | $2,699.20 | $9,634.16 |
- 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
- $1,390.55 / $1,956.07 / $4,327.46
| Professional | | $1,390.55 | $1,956.07 | $4,327.46 |