- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,747.00 / $4,806.64
| Facility | | $2,663.12 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,484.19 / $2,852.96 / $4,114.38
| Professional | | $2,484.19 | $2,852.96 | $4,114.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $25,550.40
| Facility | | $55.00 | $2,854.00 | $25,550.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,687.81 / $5,336.06 / $20,007.43
| Professional | | $2,687.81 | $5,336.06 | $20,007.43 |
- 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
- $2,091.89 / $4,712.81 / $9,772.95
| Professional | | $2,091.89 | $4,712.81 | $9,772.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,589.70 / $6,679.00
| Facility | | $300.00 | $3,589.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,168.60 / $4,003.90 / $5,881.59
| Professional | | $3,168.60 | $4,003.90 | $5,881.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,507.81 / $6,868.29 / $8,494.57
| Professional | | $3,507.81 | $6,868.29 | $8,494.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $25,550.40
| Facility | | $55.00 | $2,446.00 | $25,550.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,008.07 / $5,624.28 / $20,007.43
| Professional | | $3,008.07 | $5,624.28 | $20,007.43 |
- 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
- $2,828.29 / $4,226.47 / $10,415.51
| Professional | | $2,828.29 | $4,226.47 | $10,415.51 |