- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.83 / $2,747.00 / $7,625.00
| Facility | | $1,225.83 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,106.11 / $1,278.48 / $1,894.01
| Professional | | $1,106.11 | $1,278.48 | $1,894.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $17,385.24
| Facility | | $55.00 | $4,751.20 | $17,385.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.24 / $2,402.96 / $11,807.05
| Professional | | $1,273.24 | $2,402.96 | $11,807.05 |
- 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
- $1,105.50 / $2,106.69 / $4,430.07
| Professional | | $1,105.50 | $2,106.69 | $4,430.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,983.11 / $6,679.00
| Facility | | $300.00 | $1,983.11 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.26 / $1,819.94 / $2,673.43
| Professional | | $1,440.26 | $1,819.94 | $2,673.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.25 / $3,111.75 / $3,845.22
| Professional | | $1,589.25 | $3,111.75 | $3,845.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,751.20 / $17,385.24
| Facility | | $55.00 | $4,751.20 | $17,385.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.49 / $2,529.42 / $11,807.05
| Professional | | $1,363.49 | $2,529.42 | $11,807.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $12,850.00
| Facility | | $1,591.00 | $4,006.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.59 / $1,880.23 / $4,699.51
| Professional | | $1,314.59 | $1,880.23 | $4,699.51 |