- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,586.30 / $2,747.00 / $4,806.64
| Facility | | $2,586.30 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,480.89 / $2,886.79 / $4,006.26
| Professional | | $2,480.89 | $2,886.79 | $4,006.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $43,263.52
| Facility | | $55.00 | $2,854.00 | $43,263.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,856.13 / $5,338.44 / $20,442.24
| Professional | | $2,856.13 | $5,338.44 | $20,442.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,313.95 / $5,434.55 / $7,361.94
| Professional | | $3,313.95 | $5,434.55 | $7,361.94 |
- 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
- $2,316.82 / $4,722.09 / $9,965.20
| Professional | | $2,316.82 | $4,722.09 | $9,965.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,673.58 / $6,679.00
| Facility | | $300.00 | $3,673.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,242.64 / $4,097.45 / $6,019.02
| Professional | | $3,242.64 | $4,097.45 | $6,019.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,581.13 / $7,011.26 / $8,660.96
| Professional | | $3,581.13 | $7,011.26 | $8,660.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $52,216.48
| Facility | | $55.00 | $2,446.00 | $52,216.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,014.25 / $5,338.44 / $20,442.24
| Professional | | $3,014.25 | $5,338.44 | $20,442.24 |
- 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
- $2,856.13 / $4,264.72 / $9,131.40
| Professional | | $2,856.13 | $4,264.72 | $9,131.40 |