- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.48 / $2,747.00 / $4,806.64
| Facility | | $1,890.48 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,661.64 / $1,974.38 / $2,688.96
| Professional | | $1,661.64 | $1,974.38 | $2,688.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $18,017.36
| Facility | | $55.00 | $2,854.00 | $18,017.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,839.74 / $3,696.48 / $14,104.32
| Professional | | $1,839.74 | $3,696.48 | $14,104.32 |
- 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
- $1,382.76 / $3,225.45 / $6,886.55
| Professional | | $1,382.76 | $3,225.45 | $6,886.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,942.14 / $6,679.00
| Facility | | $300.00 | $2,942.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,244.80 / $2,837.07 / $4,166.81
| Professional | | $2,244.80 | $2,837.07 | $4,166.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,466.61 / $4,829.62 / $6,208.46
| Professional | | $2,466.61 | $4,829.62 | $6,208.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $18,017.36
| Facility | | $55.00 | $2,446.00 | $18,017.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.09 / $3,893.89 / $14,104.32
| Professional | | $2,058.09 | $3,893.89 | $14,104.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,904.25 / $2,787.49 / $7,265.04
| Professional | | $1,904.25 | $2,787.49 | $7,265.04 |