- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,287.77 / $2,747.00 / $4,806.64
| Facility | | $1,287.77 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,151.93 / $1,341.54 / $2,006.32
| Professional | | $1,151.93 | $1,341.54 | $2,006.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,660.47
| Facility | | $55.00 | $2,854.00 | $13,660.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,253.09 / $2,546.81 / $9,507.20
| Professional | | $1,253.09 | $2,546.81 | $9,507.20 |
- 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
- $1,038.14 / $2,205.39 / $4,644.18
| Professional | | $1,038.14 | $2,205.39 | $4,644.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,077.61 / $6,679.00
| Facility | | $300.00 | $2,077.61 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,508.89 / $1,906.66 / $2,800.82
| Professional | | $1,508.89 | $1,906.66 | $2,800.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,665.02 / $3,260.11 / $4,028.56
| Professional | | $1,665.02 | $3,260.11 | $4,028.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,660.47
| Facility | | $55.00 | $2,446.00 | $13,660.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,417.60 / $2,655.38 / $9,507.20
| Professional | | $1,417.60 | $2,655.38 | $9,507.20 |
- 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
- $1,303.30 / $1,969.79 / $4,564.59
| Professional | | $1,303.30 | $1,969.79 | $4,564.59 |