- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.67 / $2,747.00 / $4,806.64
| Facility | | $2,057.67 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,842.51 / $2,160.23 / $3,178.65
| Professional | | $1,842.51 | $2,160.23 | $3,178.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $19,270.88
| Facility | | $55.00 | $2,854.00 | $19,270.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,095.62 / $4,037.45 / $15,088.88
| Professional | | $2,095.62 | $4,037.45 | $15,088.88 |
- 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
- $1,273.42 / $3,512.79 / $7,374.55
| Professional | | $1,273.42 | $3,512.79 | $7,374.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,131.92 / $6,679.00
| Facility | | $300.00 | $3,131.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,391.92 / $3,022.48 / $4,439.92
| Professional | | $2,391.92 | $3,022.48 | $4,439.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,644.38 / $5,177.70 / $6,409.02
| Professional | | $2,644.38 | $5,177.70 | $6,409.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,270.88
| Facility | | $55.00 | $2,446.00 | $19,270.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,270.40 / $4,249.14 / $15,088.88
| Professional | | $2,270.40 | $4,249.14 | $15,088.88 |
- 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
- $2,201.86 / $3,122.17 / $6,818.09
| Professional | | $2,201.86 | $3,122.17 | $6,818.09 |