- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,761.45 / $4,806.64
| Facility | | $2,663.12 | $2,761.45 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,496.48 / $2,801.97 / $4,165.18
| Professional | | $2,496.48 | $2,801.97 | $4,165.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $34,123.32
| Facility | | $55.00 | $2,854.00 | $34,123.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.85 / $5,316.60 / $19,662.40
| Professional | | $2,683.85 | $5,316.60 | $19,662.40 |
- 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
- $2,051.50 / $4,451.74 / $8,609.34
| Professional | | $2,051.50 | $4,451.74 | $8,609.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,518.31 / $6,679.00
| Facility | | $300.00 | $3,518.31 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,105.58 / $3,946.48 / $5,948.99
| Professional | | $3,105.58 | $3,946.48 | $5,948.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,350.53 / $6,560.34 / $8,344.83
| Professional | | $3,350.53 | $6,560.34 | $8,344.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $34,123.32
| Facility | | $55.00 | $2,446.00 | $34,123.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,889.08 / $5,396.25 / $19,662.40
| Professional | | $2,889.08 | $5,396.25 | $19,662.40 |
- 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
- $2,796.06 / $3,917.33 / $9,104.11
| Professional | | $2,796.06 | $3,917.33 | $9,104.11 |