- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.75 / $2,747.00 / $4,806.64
| Facility | | $974.75 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.76 / $1,014.25 / $1,512.49
| Professional | | $881.76 | $1,014.25 | $1,512.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,354.40 / $9,183.76
| Facility | | $55.00 | $2,354.40 | $9,183.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.67 / $1,924.07 / $7,189.92
| Professional | | $988.67 | $1,924.07 | $7,189.92 |
- 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
- $758.84 / $1,667.89 / $3,507.00
| Professional | | $758.84 | $1,667.89 | $3,507.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,909.00 / $6,679.00
| Facility | | $578.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,141.03 / $1,441.82 / $2,117.98
| Professional | | $1,141.03 | $1,441.82 | $2,117.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.52 / $2,465.08 / $3,045.09
| Professional | | $1,259.52 | $2,465.08 | $3,045.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $9,183.76
| Facility | | $55.00 | $2,446.00 | $9,183.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.85 / $2,007.31 / $7,189.92
| Professional | | $1,071.85 | $2,007.31 | $7,189.92 |
- 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
- $1,022.21 / $1,484.54 / $3,293.77
| Professional | | $1,022.21 | $1,484.54 | $3,293.77 |