- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.01 / $2,747.00 / $4,806.64
| Facility | | $1,415.01 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.50 / $1,475.91 / $2,162.37
| Professional | | $1,279.50 | $1,475.91 | $2,162.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,287.76
| Facility | | $55.00 | $2,854.00 | $13,287.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.83 / $2,791.19 / $10,403.36
| Professional | | $1,462.83 | $2,791.19 | $10,403.36 |
- 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
- $1,189.18 / $2,426.17 / $5,088.18
| Professional | | $1,189.18 | $2,426.17 | $5,088.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,273.92 / $6,679.00
| Facility | | $300.00 | $2,273.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.47 / $2,086.83 / $3,065.47
| Professional | | $1,651.47 | $2,086.83 | $3,065.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,821.90 / $3,567.28 / $4,412.18
| Professional | | $1,821.90 | $3,567.28 | $4,412.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,287.76
| Facility | | $55.00 | $2,446.00 | $13,287.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,556.93 / $2,914.43 / $10,403.36
| Professional | | $1,556.93 | $2,914.43 | $10,403.36 |
- 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
- $1,527.00 / $2,105.65 / $5,012.58
| Professional | | $1,527.00 | $2,105.65 | $5,012.58 |