- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.03 / $2,747.00 / $5,454.00
| Facility | | $2,200.03 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,024.50 / $2,316.56 / $3,449.54
| Professional | | $2,024.50 | $2,316.56 | $3,449.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,661.43
| Facility | | $55.00 | $2,854.00 | $20,661.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,241.01 / $4,317.58 / $16,177.76
| Professional | | $2,241.01 | $4,317.58 | $16,177.76 |
- 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
- $1,157.42 / $3,759.37 / $7,894.97
| Professional | | $1,157.42 | $3,759.37 | $7,894.97 |
- 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
- $2,562.71 / $3,238.30 / $4,756.95
| Professional | | $2,562.71 | $3,238.30 | $4,756.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,836.48 / $5,553.83 / $6,869.37
| Professional | | $2,836.48 | $5,553.83 | $6,869.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $20,661.43
| Facility | | $55.00 | $2,446.00 | $20,661.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,450.66 / $4,550.58 / $16,177.76
| Professional | | $2,450.66 | $4,550.58 | $16,177.76 |
- 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
- $2,232.04 / $3,336.20 / $7,307.77
| Professional | | $2,232.04 | $3,336.20 | $7,307.77 |