- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.09 / $2,747.00 / $4,806.64
| Facility | | $2,278.09 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,013.57 / $2,313.92 / $3,524.20
| Professional | | $2,013.57 | $2,313.92 | $3,524.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $39,835.83
| Facility | | $55.00 | $2,854.00 | $39,835.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,304.86 / $4,221.32 / $15,623.44
| Professional | | $2,304.86 | $4,221.32 | $15,623.44 |
- 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
- $1,770.04 / $3,717.53 / $7,612.94
| Professional | | $1,770.04 | $3,717.53 | $7,612.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,229.08 / $6,679.00
| Facility | | $300.00 | $3,229.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,466.14 / $3,116.25 / $4,736.93
| Professional | | $2,466.14 | $3,116.25 | $4,736.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,733.26 / $5,351.72 / $6,633.23
| Professional | | $2,733.26 | $5,351.72 | $6,633.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $39,835.83
| Facility | | $55.00 | $2,446.00 | $39,835.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,470.25 / $4,397.97 / $15,623.44
| Professional | | $2,470.25 | $4,397.97 | $15,623.44 |
- 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
- $2,353.40 / $3,252.55 / $7,520.01
| Professional | | $2,353.40 | $3,252.55 | $7,520.01 |