- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,900.00 / $4,806.64
| Facility | | $2,663.12 | $2,900.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,868.14 / $4,507.41 / $6,496.57
| Professional | | $3,868.14 | $4,507.41 | $6,496.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,101.28 / $63,569.44
| Facility | | $55.00 | $3,101.28 | $63,569.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,101.28 / $7,987.91 / $30,001.76
| Professional | | $3,101.28 | $7,987.91 | $30,001.76 |
- 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
- $2,465.03 / $7,112.96 / $14,571.92
| Professional | | $2,465.03 | $7,112.96 | $14,571.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,190.95 / $8,090.00
| Facility | | $300.00 | $5,190.95 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,727.47 / $5,973.71 / $8,775.17
| Professional | | $4,727.47 | $5,973.71 | $8,775.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,253.12 / $10,285.61 / $12,750.31
| Professional | | $5,253.12 | $10,285.61 | $12,750.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $76,487.36
| Facility | | $55.00 | $2,446.00 | $76,487.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,243.58 / $8,516.50 / $30,001.76
| Professional | | $3,243.58 | $8,516.50 | $30,001.76 |
- 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
- $3,005.92 / $6,141.77 / $14,523.48
| Professional | | $3,005.92 | $6,141.77 | $14,523.48 |