- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.29 / $2,747.00 / $4,806.64
| Facility | | $1,803.29 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.77 / $1,876.48 / $2,794.89
| Professional | | $1,620.77 | $1,876.48 | $2,794.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $19,055.70
| Facility | | $55.00 | $2,854.00 | $19,055.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,843.13 / $3,563.27 / $13,261.12
| Professional | | $1,843.13 | $3,563.27 | $13,261.12 |
- 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
- $1,513.81 / $3,097.41 / $6,492.29
| Professional | | $1,513.81 | $3,097.41 | $6,492.29 |
- 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
- $2,105.86 / $2,661.00 / $3,908.91
| Professional | | $2,105.86 | $2,661.00 | $3,908.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,322.02 / $4,546.52 / $5,626.83
| Professional | | $2,322.02 | $4,546.52 | $5,626.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $19,055.70
| Facility | | $55.00 | $2,446.00 | $19,055.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.85 / $3,718.32 / $13,261.12
| Professional | | $1,983.85 | $3,718.32 | $13,261.12 |
- 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
- $1,894.29 / $2,751.14 / $6,399.33
| Professional | | $1,894.29 | $2,751.14 | $6,399.33 |