- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.62 / $2,822.00 / $6,075.00
| Facility | | $1,325.62 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.41 / $1,475.98 / $2,039.67
| Professional | | $1,304.41 | $1,475.98 | $2,039.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $13,345.28
| Facility | | $55.00 | $2,854.00 | $13,345.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.25 / $2,792.63 / $10,447.84
| Professional | | $1,466.25 | $2,792.63 | $10,447.84 |
- 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
- $1,090.40 / $2,425.42 / $5,099.07
| Professional | | $1,090.40 | $2,425.42 | $5,099.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,281.77 / $6,679.00
| Facility | | $300.00 | $2,281.77 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.17 / $2,094.03 / $3,076.06
| Professional | | $1,657.17 | $2,094.03 | $3,076.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.91 / $3,583.86 / $4,427.13
| Professional | | $1,830.91 | $3,583.86 | $4,427.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $13,345.28
| Facility | | $55.00 | $2,446.00 | $13,345.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,587.25 / $2,919.08 / $10,447.84
| Professional | | $1,587.25 | $2,919.08 | $10,447.84 |
- 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
- $1,559.43 / $2,258.71 / $5,562.43
| Professional | | $1,559.43 | $2,258.71 | $5,562.43 |