- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,188.30 / $2,747.00 / $5,454.00
| Facility | | $2,188.30 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,986.35 / $2,221.81 / $3,298.65
| Professional | | $1,986.35 | $2,221.81 | $3,298.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $19,716.40
| Facility | | $55.00 | $2,854.00 | $19,716.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.73 / $4,231.67 / $15,614.48
| Professional | | $2,159.73 | $4,231.67 | $15,614.48 |
- 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
- $1,627.82 / $3,529.62 / $6,843.26
| Professional | | $1,627.82 | $3,529.62 | $6,843.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,259.54 / $6,679.00
| Facility | | $300.00 | $3,259.54 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,469.71 / $3,143.12 / $4,826.43
| Professional | | $2,469.71 | $3,143.12 | $4,826.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,661.17 / $5,210.57 / $6,627.91
| Professional | | $2,661.17 | $5,210.57 | $6,627.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,406.01 / $6,406.01 / $6,726.31
| Professional | | $6,406.01 | $6,406.01 | $6,726.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,716.40
| Facility | | $55.00 | $2,446.00 | $19,716.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,363.83 / $4,267.47 / $15,614.48
| Professional | | $2,363.83 | $4,267.47 | $15,614.48 |
- 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
- $2,183.30 / $3,348.90 / $7,264.59
| Professional | | $2,183.30 | $3,348.90 | $7,264.59 |