- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,757.06 / $4,806.64
| Facility | | $2,663.12 | $2,757.06 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,527.19 / $2,894.63 / $6,895.25
| Professional | | $2,527.19 | $2,894.63 | $6,895.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $29,063.16
| Facility | | $55.00 | $2,854.00 | $29,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,864.84 / $5,416.98 / $20,228.24
| Professional | | $2,864.84 | $5,416.98 | $20,228.24 |
- 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
- $2,321.38 / $4,719.16 / $9,892.86
| Professional | | $2,321.38 | $4,719.16 | $9,892.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,632.95 / $6,679.00
| Facility | | $300.00 | $3,632.95 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,206.78 / $4,052.14 / $5,952.46
| Professional | | $3,206.78 | $4,052.14 | $5,952.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,544.68 / $6,940.48 / $8,596.19
| Professional | | $3,544.68 | $6,940.48 | $8,596.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $29,063.16
| Facility | | $55.00 | $2,446.00 | $29,063.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,083.82 / $5,704.46 / $20,228.24
| Professional | | $3,083.82 | $5,704.46 | $20,228.24 |
- 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
- $3,047.77 / $4,248.22 / $10,585.02
| Professional | | $3,047.77 | $4,248.22 | $10,585.02 |