- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.58 / $2,747.00 / $4,806.64
| Facility | | $2,447.58 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,262.44 / $2,568.44 / $3,821.66
| Professional | | $2,262.44 | $2,568.44 | $3,821.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $41,732.00
| Facility | | $55.00 | $2,854.00 | $41,732.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.07 / $4,793.32 / $18,006.88
| Professional | | $2,578.07 | $4,793.32 | $18,006.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,906.35 / $4,766.12 / $6,795.05
| Professional | | $2,906.35 | $4,766.12 | $6,795.05 |
- 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
- $2,052.10 / $4,184.68 / $8,703.43
| Professional | | $2,052.10 | $4,184.68 | $8,703.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,472.00 / $6,679.00
| Facility | | $300.00 | $3,472.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,849.68 / $3,600.90 / $5,289.60
| Professional | | $2,849.68 | $3,600.90 | $5,289.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.05 / $6,165.09 / $7,615.70
| Professional | | $3,151.05 | $6,165.09 | $7,615.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $45,948.32
| Facility | | $55.00 | $2,446.00 | $45,948.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.71 / $5,021.14 / $18,006.88
| Professional | | $2,753.71 | $5,021.14 | $18,006.88 |
- 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
- $2,682.16 / $3,761.87 / $8,605.86
| Professional | | $2,682.16 | $3,761.87 | $8,605.86 |