- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.23 / $2,747.00 / $4,806.64
| Facility | | $1,851.23 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,711.87 / $1,897.77 / $2,868.97
| Professional | | $1,711.87 | $1,897.77 | $2,868.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,825.52
| Facility | | $55.00 | $2,854.00 | $16,825.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,943.34 / $3,578.83 / $13,405.52
| Professional | | $1,943.34 | $3,578.83 | $13,405.52 |
- 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
- $1,451.07 / $3,119.52 / $6,448.35
| Professional | | $1,451.07 | $3,119.52 | $6,448.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,867.00 / $6,679.00
| Facility | | $300.00 | $2,867.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,087.37 / $2,637.64 / $3,874.60
| Professional | | $2,087.37 | $2,637.64 | $3,874.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,273.28 / $4,451.08 / $5,514.24
| Professional | | $2,273.28 | $4,451.08 | $5,514.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,825.52
| Facility | | $55.00 | $2,446.00 | $16,825.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.81 / $3,681.71 / $13,405.52
| Professional | | $2,055.81 | $3,681.71 | $13,405.52 |
- 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
- $1,957.37 / $2,855.21 / $6,141.78
| Professional | | $1,957.37 | $2,855.21 | $6,141.78 |