- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.21 / $2,747.00 / $4,806.64
| Facility | | $1,197.21 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.67 / $1,246.49 / $1,855.34
| Professional | | $1,075.67 | $1,246.49 | $1,855.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,747.16 / $11,283.44
| Facility | | $55.00 | $2,747.16 | $11,283.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.04 / $2,370.44 / $8,834.87
| Professional | | $1,202.04 | $2,370.44 | $8,834.87 |
- 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
- $1,005.59 / $2,056.48 / $4,319.30
| Professional | | $1,005.59 | $2,056.48 | $4,319.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,931.53 / $6,679.00
| Facility | | $300.00 | $1,931.53 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.81 / $1,772.61 / $2,603.90
| Professional | | $1,402.81 | $1,772.61 | $2,603.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.65 / $3,028.34 / $3,743.59
| Professional | | $1,546.65 | $3,028.34 | $3,743.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,283.44
| Facility | | $55.00 | $2,446.00 | $11,283.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.83 / $2,465.86 / $8,834.87
| Professional | | $1,315.83 | $2,465.86 | $8,834.87 |
- 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
- $1,243.43 / $1,831.36 / $4,585.97
| Professional | | $1,243.43 | $1,831.36 | $4,585.97 |