- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,651.41 / $2,747.00 / $4,806.64
| Facility | | $2,651.41 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,474.98 / $2,809.84 / $4,138.24
| Professional | | $2,474.98 | $2,809.84 | $4,138.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $27,678.42
| Facility | | $55.00 | $2,854.00 | $27,678.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,837.77 / $5,248.85 / $21,347.14
| Professional | | $2,837.77 | $5,248.85 | $21,347.14 |
- 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
- $2,163.58 / $4,531.03 / $9,400.14
| Professional | | $2,163.58 | $4,531.03 | $9,400.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,504.00 / $6,679.00
| Facility | | $300.00 | $3,504.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,050.24 / $3,854.33 / $5,712.76
| Professional | | $3,050.24 | $3,854.33 | $5,712.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,334.55 / $6,529.05 / $8,129.86
| Professional | | $3,334.55 | $6,529.05 | $8,129.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $27,678.42
| Facility | | $55.00 | $2,446.00 | $27,678.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,977.88 / $5,431.71 / $21,347.14
| Professional | | $2,977.88 | $5,431.71 | $21,347.14 |
- 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
- $2,837.77 / $4,189.63 / $9,066.41
| Professional | | $2,837.77 | $4,189.63 | $9,066.41 |