- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,773.63 / $2,747.00 / $4,806.64
| Facility | | $1,773.63 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,610.74 / $1,841.14 / $2,853.37
| Professional | | $1,610.74 | $1,841.14 | $2,853.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,114.48
| Facility | | $55.00 | $2,854.00 | $16,114.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.68 / $3,410.43 / $12,831.36
| Professional | | $1,823.68 | $3,410.43 | $12,831.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,430.80 / $3,349.81 / $4,444.28
| Professional | | $2,430.80 | $3,349.81 | $4,444.28 |
- 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
- $1,343.52 / $3,003.78 / $6,181.88
| Professional | | $1,343.52 | $3,003.78 | $6,181.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,756.01 / $6,679.00
| Facility | | $300.00 | $2,756.01 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.60 / $2,529.25 / $3,715.38
| Professional | | $2,001.60 | $2,529.25 | $3,715.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.61 / $4,261.80 / $5,283.08
| Professional | | $2,176.61 | $4,261.80 | $5,283.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,114.48
| Facility | | $55.00 | $2,446.00 | $16,114.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.49 / $3,522.77 / $12,831.36
| Professional | | $1,928.49 | $3,522.77 | $12,831.36 |
- 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
- $1,791.83 / $2,736.29 / $7,283.47
| Professional | | $1,791.83 | $2,736.29 | $7,283.47 |