- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,079.71 / $2,747.00 / $4,806.64
| Facility | | $2,079.71 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,932.32 / $2,235.67 / $3,336.05
| Professional | | $1,932.32 | $2,235.67 | $3,336.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $16,623.84
| Facility | | $55.00 | $2,733.00 | $16,623.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,311.90 / $4,081.43 / $18,462.88
| Professional | | $2,311.90 | $4,081.43 | $18,462.88 |
- 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
- $1,658.47 / $3,671.21 / $7,705.05
| Professional | | $1,658.47 | $3,671.21 | $7,705.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,266.93 / $6,679.00
| Facility | | $300.00 | $3,266.93 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,495.04 / $3,152.78 / $4,689.25
| Professional | | $2,495.04 | $3,152.78 | $4,689.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,752.92 / $5,390.22 / $6,674.07
| Professional | | $2,752.92 | $5,390.22 | $6,674.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,077.52
| Facility | | $55.00 | $2,446.00 | $20,077.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,425.52 / $4,430.70 / $18,462.88
| Professional | | $2,425.52 | $4,430.70 | $18,462.88 |
- 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
- $2,354.36 / $3,263.72 / $8,238.68
| Professional | | $2,354.36 | $3,263.72 | $8,238.68 |