- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.21 / $2,747.00 / $4,806.64
| Facility | | $1,818.21 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,665.59 / $1,874.96 / $2,785.36
| Professional | | $1,665.59 | $1,874.96 | $2,785.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,382.96
| Facility | | $55.00 | $2,854.00 | $16,382.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.62 / $3,470.90 / $13,059.92
| Professional | | $1,907.62 | $3,470.90 | $13,059.92 |
- 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
- $1,471.82 / $3,049.06 / $6,259.83
| Professional | | $1,471.82 | $3,049.06 | $6,259.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,795.72 / $6,679.00
| Facility | | $300.00 | $2,795.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.43 / $2,565.69 / $3,768.91
| Professional | | $2,030.43 | $2,565.69 | $3,768.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,213.89 / $4,334.80 / $5,363.79
| Professional | | $2,213.89 | $4,334.80 | $5,363.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,382.96
| Facility | | $55.00 | $2,446.00 | $16,382.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.30 / $3,653.53 / $13,059.92
| Professional | | $2,025.30 | $3,653.53 | $13,059.92 |
- 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
- $1,928.28 / $2,646.90 / $5,890.54
| Professional | | $1,928.28 | $2,646.90 | $5,890.54 |