- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.23 / $2,747.00 / $4,806.64
| Facility | | $2,063.23 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.90 / $2,155.06 / $3,003.89
| Professional | | $1,798.90 | $2,155.06 | $3,003.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $19,634.96
| Facility | | $55.00 | $2,854.00 | $19,634.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,037.00 / $4,132.83 / $15,370.48
| Professional | | $2,037.00 | $4,132.83 | $15,370.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,774.70 / $4,114.13 / $5,573.23
| Professional | | $2,774.70 | $4,114.13 | $5,573.23 |
- 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
- $1,441.72 / $3,547.92 / $7,503.27
| Professional | | $1,441.72 | $3,547.92 | $7,503.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,202.14 / $6,679.00
| Facility | | $300.00 | $3,202.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,445.07 / $3,089.63 / $4,538.56
| Professional | | $2,445.07 | $3,089.63 | $4,538.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,689.02 / $5,265.10 / $6,768.26
| Professional | | $2,689.02 | $5,265.10 | $6,768.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,634.96
| Facility | | $55.00 | $2,446.00 | $19,634.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,264.98 / $4,249.85 / $15,370.48
| Professional | | $2,264.98 | $4,249.85 | $15,370.48 |
- 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
- $2,103.73 / $3,188.81 / $8,895.90
| Professional | | $2,103.73 | $3,188.81 | $8,895.90 |