- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.76 / $2,747.00 / $4,806.64
| Facility | | $1,299.76 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,169.06 / $1,353.07 / $2,016.14
| Professional | | $1,169.06 | $1,353.07 | $2,016.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $12,211.36
| Facility | | $55.00 | $2,854.00 | $12,211.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.37 / $2,567.52 / $9,559.44
| Professional | | $1,323.37 | $2,567.52 | $9,559.44 |
- 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
- $1,090.71 / $2,230.52 / $4,677.41
| Professional | | $1,090.71 | $2,230.52 | $4,677.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,090.61 / $6,679.00
| Facility | | $300.00 | $2,090.61 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.34 / $1,918.60 / $2,818.35
| Professional | | $1,518.34 | $1,918.60 | $2,818.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.04 / $3,277.77 / $4,053.48
| Professional | | $1,674.04 | $3,277.77 | $4,053.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $12,211.36
| Facility | | $55.00 | $2,446.00 | $12,211.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.34 / $2,675.33 / $9,559.44
| Professional | | $1,427.34 | $2,675.33 | $9,559.44 |
- 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
- $1,380.94 / $1,983.94 / $4,288.81
| Professional | | $1,380.94 | $1,983.94 | $4,288.81 |