- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.67 / $2,747.00 / $5,454.00
| Facility | | $1,343.67 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.70 / $1,343.67 / $2,059.60
| Professional | | $1,171.70 | $1,343.67 | $2,059.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $23,580.80
| Facility | | $55.00 | $2,854.00 | $23,580.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.19 / $2,471.44 / $9,244.32
| Professional | | $1,313.19 | $2,471.44 | $9,244.32 |
- 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
- $1,268.25 / $2,162.54 / $4,501.13
| Professional | | $1,268.25 | $2,162.54 | $4,501.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,015.92 / $6,679.00
| Facility | | $300.00 | $2,015.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,464.10 / $1,850.06 / $2,795.60
| Professional | | $1,464.10 | $1,850.06 | $2,795.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.46 / $3,163.07 / $3,912.97
| Professional | | $1,615.46 | $3,163.07 | $3,912.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $23,580.80
| Facility | | $55.00 | $2,446.00 | $23,580.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.65 / $2,573.64 / $9,244.32
| Professional | | $1,410.65 | $2,573.64 | $9,244.32 |
- 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
- $1,334.93 / $1,909.03 / $4,310.25
| Professional | | $1,334.93 | $1,909.03 | $4,310.25 |