- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.73 / $2,747.00 / $4,806.64
| Facility | | $2,093.73 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,885.59 / $2,184.62 / $3,216.87
| Professional | | $1,885.59 | $2,184.62 | $3,216.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $16,222.64
| Facility | | $55.00 | $2,733.00 | $16,222.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,254.86 / $3,983.03 / $17,956.93
| Professional | | $2,254.86 | $3,983.03 | $17,956.93 |
- 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
- $1,617.78 / $3,599.04 / $7,518.30
| Professional | | $1,617.78 | $3,599.04 | $7,518.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,188.62 / $6,679.00
| Facility | | $300.00 | $3,188.62 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.23 / $3,077.20 / $4,573.93
| Professional | | $2,435.23 | $3,077.20 | $4,573.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,686.57 / $5,260.30 / $6,511.66
| Professional | | $2,686.57 | $5,260.30 | $6,511.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,594.00
| Facility | | $55.00 | $2,446.00 | $19,594.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.54 / $4,322.96 / $17,956.93
| Professional | | $2,366.54 | $4,322.96 | $17,956.93 |
- 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
- $2,270.35 / $3,238.91 / $7,437.72
| Professional | | $2,270.35 | $3,238.91 | $7,437.72 |