- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.72 / $2,747.00 / $4,806.64
| Facility | | $1,081.72 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.72 / $1,176.17 / $1,679.88
| Professional | | $1,081.72 | $1,176.17 | $1,679.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,410.67
| Facility | | $55.00 | $2,446.00 | $13,410.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.80 / $2,074.55 / $7,803.28
| Professional | | $1,171.80 | $2,074.55 | $7,803.28 |
- 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
- $1,075.68 / $1,940.39 / $3,804.97
| Professional | | $1,075.68 | $1,940.39 | $3,804.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,714.41 / $6,679.00
| Facility | | $300.00 | $1,714.41 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,232.17 / $1,557.00 / $2,579.73
| Professional | | $1,232.17 | $1,557.00 | $2,579.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.20 / $2,673.06 / $3,311.13
| Professional | | $1,365.20 | $2,673.06 | $3,311.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,167.58
| Facility | | $55.00 | $2,446.00 | $16,167.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,254.38 / $2,199.44 / $7,803.28
| Professional | | $1,254.38 | $2,199.44 | $7,803.28 |
- 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
- $1,228.13 / $1,865.79 / $4,046.00
| Professional | | $1,228.13 | $1,865.79 | $4,046.00 |