- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.92 / $2,747.00 / $4,806.64
| Facility | | $1,560.92 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.68 / $1,633.07 / $2,419.50
| Professional | | $1,417.68 | $1,633.07 | $2,419.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,523.00
| Facility | | $55.00 | $2,854.00 | $16,523.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.58 / $3,076.76 / $11,499.68
| Professional | | $1,619.58 | $3,076.76 | $11,499.68 |
- 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
- $1,313.66 / $2,676.14 / $5,616.37
| Professional | | $1,313.66 | $2,676.14 | $5,616.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,511.19 / $6,679.00
| Facility | | $300.00 | $2,511.19 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.80 / $2,304.59 / $3,385.36
| Professional | | $1,823.80 | $2,304.59 | $3,385.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,014.82 / $3,945.02 / $4,878.52
| Professional | | $2,014.82 | $3,945.02 | $4,878.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,523.00
| Facility | | $55.00 | $2,446.00 | $16,523.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,722.45 / $3,222.04 / $11,499.68
| Professional | | $1,722.45 | $3,222.04 | $11,499.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.57 / $2,377.13 / $5,980.59
| Professional | | $1,683.57 | $2,377.13 | $5,980.59 |