- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.42 / $2,747.00 / $4,806.64
| Facility | | $2,224.42 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,984.43 / $2,307.83 / $3,384.71
| Professional | | $1,984.43 | $2,307.83 | $3,384.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,592.88
| Facility | | $55.00 | $2,854.00 | $20,592.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,179.88 / $4,333.51 / $17,258.00
| Professional | | $2,179.88 | $4,333.51 | $17,258.00 |
- 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
- $1,527.33 / $3,777.16 / $7,897.90
| Professional | | $1,527.33 | $3,777.16 | $7,897.90 |
- 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
- $2,559.64 / $3,234.40 / $4,751.22
| Professional | | $2,559.64 | $3,234.40 | $4,751.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,823.37 / $5,528.16 / $6,847.47
| Professional | | $2,823.37 | $5,528.16 | $6,847.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,592.88
| Facility | | $55.00 | $2,446.00 | $20,592.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.44 / $4,559.30 / $17,258.00
| Professional | | $2,432.44 | $4,559.30 | $17,258.00 |
- 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
- $2,290.00 / $3,354.30 / $8,483.07
| Professional | | $2,290.00 | $3,354.30 | $8,483.07 |