- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.12 / $2,747.00 / $4,806.64
| Facility | | $1,875.12 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,734.65 / $1,980.51 / $2,931.75
| Professional | | $1,734.65 | $1,980.51 | $2,931.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $17,791.12
| Facility | | $55.00 | $2,854.00 | $17,791.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,968.11 / $3,717.52 / $13,931.28
| Professional | | $1,968.11 | $3,717.52 | $13,931.28 |
- 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
- $1,513.49 / $3,232.27 / $6,796.29
| Professional | | $1,513.49 | $3,232.27 | $6,796.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,889.86 / $6,679.00
| Facility | | $300.00 | $2,889.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.07 / $2,788.89 / $4,096.78
| Professional | | $2,207.07 | $2,788.89 | $4,096.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.04 / $4,781.51 / $5,911.83
| Professional | | $2,442.04 | $4,781.51 | $5,911.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $17,791.12
| Facility | | $55.00 | $2,446.00 | $17,791.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.23 / $3,907.71 / $13,931.28
| Professional | | $2,089.23 | $3,907.71 | $13,931.28 |
- 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
- $2,033.36 / $2,872.25 / $6,698.52
| Professional | | $2,033.36 | $2,872.25 | $6,698.52 |