- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,785.17 / $2,747.00 / $4,806.64
| Facility | | $1,785.17 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,624.86 / $1,879.21 / $2,758.44
| Professional | | $1,624.86 | $1,879.21 | $2,758.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $29,442.56
| Facility | | $55.00 | $2,854.00 | $29,442.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.22 / $3,527.47 / $13,171.76
| Professional | | $1,815.22 | $3,527.47 | $13,171.76 |
- 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
- $1,383.66 / $3,068.41 / $6,438.09
| Professional | | $1,383.66 | $3,068.41 | $6,438.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,867.00 / $6,679.00
| Facility | | $300.00 | $2,867.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.35 / $2,640.13 / $3,878.26
| Professional | | $2,089.35 | $2,640.13 | $3,878.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,308.10 / $4,519.26 / $5,589.98
| Professional | | $2,308.10 | $4,519.26 | $5,589.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $29,442.56
| Facility | | $55.00 | $2,446.00 | $29,442.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.85 / $3,703.09 / $13,171.76
| Professional | | $1,977.85 | $3,703.09 | $13,171.76 |
- 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
- $1,815.40 / $2,635.36 / $6,035.91
| Professional | | $1,815.40 | $2,635.36 | $6,035.91 |