- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,747.00 / $4,806.64
| Facility | | $2,663.12 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,523.64 / $2,881.55 / $4,250.85
| Professional | | $2,523.64 | $2,881.55 | $4,250.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $41,909.92
| Facility | | $55.00 | $2,854.00 | $41,909.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,434.00 / $5,255.75 / $19,801.12
| Professional | | $2,434.00 | $5,255.75 | $19,801.12 |
- 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
- $2,110.46 / $4,680.93 / $9,630.84
| Professional | | $2,110.46 | $4,680.93 | $9,630.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,539.25 / $6,679.00
| Facility | | $300.00 | $3,539.25 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,124.07 / $3,947.63 / $5,798.93
| Professional | | $3,124.07 | $3,947.63 | $5,798.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,465.22 / $6,784.90 / $8,408.86
| Professional | | $3,465.22 | $6,784.90 | $8,408.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $50,487.52
| Facility | | $55.00 | $2,446.00 | $50,487.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,665.89 / $5,582.49 / $19,801.12
| Professional | | $2,665.89 | $5,582.49 | $19,801.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,476.51 / $3,967.21 / $9,224.20
| Professional | | $2,476.51 | $3,967.21 | $9,224.20 |