- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.56 / $2,747.00 / $4,806.64
| Facility | | $1,260.56 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.54 / $1,309.42 / $1,950.17
| Professional | | $1,129.54 | $1,309.42 | $1,950.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,837.84
| Facility | | $55.00 | $2,854.00 | $11,837.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,285.10 / $2,490.56 / $9,268.32
| Professional | | $1,285.10 | $2,490.56 | $9,268.32 |
- 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
- $1,057.33 / $2,156.94 / $4,536.10
| Professional | | $1,057.33 | $2,156.94 | $4,536.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,026.98 / $6,679.00
| Facility | | $300.00 | $2,026.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.13 / $1,860.21 / $2,732.58
| Professional | | $1,472.13 | $1,860.21 | $2,732.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.43 / $3,176.72 / $3,930.92
| Professional | | $1,622.43 | $3,176.72 | $3,930.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,837.84
| Facility | | $55.00 | $2,446.00 | $11,837.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.04 / $2,594.54 / $9,268.32
| Professional | | $1,384.04 | $2,594.54 | $9,268.32 |
- 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
- $1,326.94 / $1,846.44 / $4,466.85
| Professional | | $1,326.94 | $1,846.44 | $4,466.85 |