- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.40 / $2,949.02 / $7,190.00
| Facility | | $1,214.40 | $2,949.02 | $7,190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.90 / $1,271.67 / $1,888.86
| Professional | | $1,108.90 | $1,271.67 | $1,888.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,094.38 / $11,458.88
| Facility | | $822.00 | $3,094.38 | $11,458.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,265.47 / $2,403.46 / $8,972.08
| Professional | | $1,265.47 | $2,403.46 | $8,972.08 |
- 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
- $1,022.00 / $2,090.67 / $4,385.29
| Professional | | $1,022.00 | $2,090.67 | $4,385.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,959.78 / $6,679.00
| Facility | | $300.00 | $1,959.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.32 / $1,798.54 / $2,641.99
| Professional | | $1,423.32 | $1,798.54 | $2,641.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,571.64 / $3,077.27 / $3,806.36
| Professional | | $1,571.64 | $3,077.27 | $3,806.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,466.00 / $11,458.88
| Facility | | $822.00 | $3,466.00 | $11,458.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.04 / $2,516.81 / $8,972.08
| Professional | | $1,348.04 | $2,516.81 | $8,972.08 |
- 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
- $1,281.75 / $1,811.72 / $4,674.45
| Professional | | $1,281.75 | $1,811.72 | $4,674.45 |