- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.47 / $2,747.00 / $4,806.64
| Facility | | $1,217.47 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.00 / $1,284.30 / $1,876.57
| Professional | | $1,120.00 | $1,284.30 | $1,876.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,789.60 / $11,442.64
| Facility | | $55.00 | $2,789.60 | $11,442.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.83 / $2,406.63 / $8,958.32
| Professional | | $1,250.83 | $2,406.63 | $8,958.32 |
- 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
- $1,021.17 / $2,080.81 / $4,383.28
| Professional | | $1,021.17 | $2,080.81 | $4,383.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $1,992.60 / $6,679.00
| Facility | | $714.00 | $1,992.60 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.97 / $1,798.09 / $2,641.33
| Professional | | $1,422.97 | $1,798.09 | $2,641.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.36 / $3,070.85 / $3,797.40
| Professional | | $1,568.36 | $3,070.85 | $3,797.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,442.64
| Facility | | $55.00 | $2,446.00 | $11,442.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,359.37 / $2,507.86 / $8,958.32
| Professional | | $1,359.37 | $2,507.86 | $8,958.32 |
- 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
- $1,313.06 / $1,860.18 / $4,667.05
| Professional | | $1,313.06 | $1,860.18 | $4,667.05 |