- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.57 / $2,747.00 / $4,806.64
| Facility | | $2,018.57 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,941.02 / $2,273.46 / $3,112.28
| Professional | | $1,941.02 | $2,273.46 | $3,112.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,690.96
| Facility | | $55.00 | $2,854.00 | $20,690.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,174.19 / $4,252.63 / $16,197.12
| Professional | | $2,174.19 | $4,252.63 | $16,197.12 |
- 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
- $1,626.75 / $3,692.36 / $7,906.23
| Professional | | $1,626.75 | $3,692.36 | $7,906.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,343.00 / $6,679.00
| Facility | | $300.00 | $3,343.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.51 / $3,254.45 / $4,780.68
| Professional | | $2,575.51 | $3,254.45 | $4,780.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,834.43 / $5,549.81 / $7,134.26
| Professional | | $2,834.43 | $5,549.81 | $7,134.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,690.96
| Facility | | $55.00 | $2,446.00 | $20,690.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.02 / $4,486.47 / $16,197.12
| Professional | | $2,392.02 | $4,486.47 | $16,197.12 |
- 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
- $2,241.32 / $3,194.87 / $7,732.05
| Professional | | $2,241.32 | $3,194.87 | $7,732.05 |