- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.66 / $2,747.00 / $4,806.64
| Facility | | $2,436.66 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,358.52 / $2,684.59 / $3,956.01
| Professional | | $2,358.52 | $2,684.59 | $3,956.01 |
- 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
- $2,665.80 / $5,068.46 / $18,979.04
| Professional | | $2,665.80 | $5,068.46 | $18,979.04 |
- 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
- $2,137.35 / $4,389.92 / $9,254.96
| Professional | | $2,137.35 | $4,389.92 | $9,254.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,504.00 / $6,679.00
| Facility | | $300.00 | $3,504.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,008.70 / $3,801.84 / $5,584.77
| Professional | | $3,008.70 | $3,801.84 | $5,584.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,325.95 / $6,512.21 / $8,046.18
| Professional | | $3,325.95 | $6,512.21 | $8,046.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $48,477.92
| Facility | | $55.00 | $2,446.00 | $48,477.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,862.89 / $5,308.94 / $18,979.04
| Professional | | $2,862.89 | $5,308.94 | $18,979.04 |
- 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
- $2,828.42 / $3,921.19 / $10,909.67
| Professional | | $2,828.42 | $3,921.19 | $10,909.67 |