- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,216.60 / $2,747.00 / $4,806.64
| Facility | | $2,216.60 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.41 / $2,507.12 / $4,050.20
| Professional | | $2,099.41 | $2,507.12 | $4,050.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $22,622.96
| Facility | | $55.00 | $2,854.00 | $22,622.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,493.88 / $4,755.03 / $17,711.91
| Professional | | $2,493.88 | $4,755.03 | $17,711.91 |
- 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
- $1,788.36 / $4,095.46 / $8,649.44
| Professional | | $1,788.36 | $4,095.46 | $8,649.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,472.00 / $6,679.00
| Facility | | $300.00 | $3,472.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,814.43 / $3,556.36 / $5,224.17
| Professional | | $2,814.43 | $3,556.36 | $5,224.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,099.85 / $6,069.51 / $7,802.32
| Professional | | $3,099.85 | $6,069.51 | $7,802.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $22,622.96
| Facility | | $55.00 | $2,446.00 | $22,622.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,623.71 / $4,918.85 / $17,711.91
| Professional | | $2,623.71 | $4,918.85 | $17,711.91 |
- 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
- $2,493.88 / $3,669.84 / $10,235.02
| Professional | | $2,493.88 | $3,669.84 | $10,235.02 |