- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,735.30 / $2,747.00 / $4,806.64
| Facility | | $1,735.30 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.22 / $1,813.53 / $2,690.74
| Professional | | $1,563.22 | $1,813.53 | $2,690.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,324.80
| Facility | | $55.00 | $2,854.00 | $16,324.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.06 / $3,414.62 / $12,782.16
| Professional | | $1,798.06 | $3,414.62 | $12,782.16 |
- 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
- $1,457.79 / $2,970.24 / $6,237.35
| Professional | | $1,457.79 | $2,970.24 | $6,237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,790.01 / $6,679.00
| Facility | | $300.00 | $2,790.01 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,026.29 / $2,560.44 / $3,761.22
| Professional | | $2,026.29 | $2,560.44 | $3,761.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.10 / $4,386.12 / $5,420.56
| Professional | | $2,240.10 | $4,386.12 | $5,420.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,324.80
| Facility | | $55.00 | $2,446.00 | $16,324.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,914.96 / $3,581.21 / $12,782.16
| Professional | | $1,914.96 | $3,581.21 | $12,782.16 |
- 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
- $1,890.16 / $2,638.05 / $6,144.27
| Professional | | $1,890.16 | $2,638.05 | $6,144.27 |