- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.74 / $2,747.00 / $4,806.64
| Facility | | $1,252.74 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.94 / $1,302.21 / $1,955.79
| Professional | | $1,139.94 | $1,302.21 | $1,955.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,765.76
| Facility | | $55.00 | $2,854.00 | $11,765.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.49 / $2,463.94 / $9,211.20
| Professional | | $1,302.49 | $2,463.94 | $9,211.20 |
- 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
- $1,052.68 / $2,140.23 / $4,497.77
| Professional | | $1,052.68 | $2,140.23 | $4,497.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,011.69 / $6,679.00
| Facility | | $300.00 | $2,011.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.02 / $1,846.17 / $2,711.96
| Professional | | $1,461.02 | $1,846.17 | $2,711.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.23 / $3,160.66 / $3,906.00
| Professional | | $1,614.23 | $3,160.66 | $3,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,765.76
| Facility | | $55.00 | $2,446.00 | $11,765.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.52 / $2,583.65 / $9,211.20
| Professional | | $1,384.52 | $2,583.65 | $9,211.20 |
- 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
- $1,320.57 / $1,880.03 / $4,436.72
| Professional | | $1,320.57 | $1,880.03 | $4,436.72 |