- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,201.55 / $2,747.00 / $4,806.64
| Facility | | $2,201.55 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.76 / $2,304.96 / $3,417.26
| Professional | | $1,996.76 | $2,304.96 | $3,417.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,701.04
| Facility | | $55.00 | $2,854.00 | $20,701.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.00 / $4,322.72 / $16,210.16
| Professional | | $2,168.00 | $4,322.72 | $16,210.16 |
- 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
- $1,606.23 / $3,763.07 / $7,907.58
| Professional | | $1,606.23 | $3,763.07 | $7,907.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,343.00 / $6,679.00
| Facility | | $300.00 | $3,343.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,566.98 / $3,243.69 / $4,764.87
| Professional | | $2,566.98 | $3,243.69 | $4,764.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,842.21 / $5,565.05 / $6,883.33
| Professional | | $2,842.21 | $5,565.05 | $6,883.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,701.04
| Facility | | $55.00 | $2,446.00 | $20,701.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.13 / $4,556.72 / $16,210.16
| Professional | | $2,437.13 | $4,556.72 | $16,210.16 |
- 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
- $2,273.35 / $3,340.05 / $7,432.66
| Professional | | $2,273.35 | $3,340.05 | $7,432.66 |