- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.93 / $2,747.00 / $7,625.00
| Facility | | $1,539.93 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.38 / $1,638.68 / $2,413.26
| Professional | | $1,426.38 | $1,638.68 | $2,413.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $22,333.44
| Facility | | $55.00 | $2,854.00 | $22,333.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.85 / $3,121.55 / $13,469.28
| Professional | | $1,635.85 | $3,121.55 | $13,469.28 |
- 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
- $1,330.50 / $2,699.12 / $5,694.01
| Professional | | $1,330.50 | $2,699.12 | $5,694.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,546.94 / $6,679.00
| Facility | | $300.00 | $2,546.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.76 / $2,337.39 / $3,433.54
| Professional | | $1,849.76 | $2,337.39 | $3,433.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.86 / $3,997.96 / $4,941.28
| Professional | | $2,041.86 | $3,997.96 | $4,941.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $22,333.44
| Facility | | $55.00 | $2,446.00 | $22,333.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.53 / $3,202.42 / $13,469.28
| Professional | | $1,738.53 | $3,202.42 | $13,469.28 |
- 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
- $1,710.10 / $2,428.52 / $5,118.13
| Professional | | $1,710.10 | $2,428.52 | $5,118.13 |