- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,784.11 / $4,806.64
| Facility | | $2,663.12 | $2,784.11 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,650.38 / $3,094.85 / $7,089.73
| Professional | | $2,650.38 | $3,094.85 | $7,089.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $46,266.88
| Facility | | $55.00 | $2,854.00 | $46,266.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,078.08 / $5,747.73 / $21,833.04
| Professional | | $3,078.08 | $5,747.73 | $21,833.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,528.15 / $5,785.81 / $7,837.79
| Professional | | $3,528.15 | $5,785.81 | $7,837.79 |
- 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
- $2,259.31 / $5,067.43 / $10,662.07
| Professional | | $2,259.31 | $5,067.43 | $10,662.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,918.36 / $6,679.00
| Facility | | $300.00 | $3,918.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,458.70 / $4,370.47 / $6,420.08
| Professional | | $3,458.70 | $4,370.47 | $6,420.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,827.30 / $7,493.85 / $9,265.79
| Professional | | $3,827.30 | $7,493.85 | $9,265.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $55,764.32
| Facility | | $55.00 | $2,446.00 | $55,764.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,258.34 / $5,747.73 / $21,833.04
| Professional | | $3,258.34 | $5,747.73 | $21,833.04 |
- 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
- $3,027.36 / $4,388.93 / $9,813.27
| Professional | | $3,027.36 | $4,388.93 | $9,813.27 |