- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,900.00 / $5,106.95
| Facility | | $2,663.12 | $2,900.00 | $5,106.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,369.54 / $5,106.95 / $7,769.79
| Professional | | $4,369.54 | $5,106.95 | $7,769.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,390.00 / $72,592.96
| Facility | | $55.00 | $3,390.00 | $72,592.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,308.45 / $9,145.31 / $34,235.76
| Professional | | $3,308.45 | $9,145.31 | $34,235.76 |
- 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
- $2,264.65 / $8,130.88 / $16,619.72
| Professional | | $2,264.65 | $8,130.88 | $16,619.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,636.65 / $8,090.00
| Facility | | $300.00 | $5,636.65 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,390.05 / $6,810.95 / $10,005.06
| Professional | | $5,390.05 | $6,810.95 | $10,005.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,996.54 / $11,741.23 / $14,562.82
| Professional | | $5,996.54 | $11,741.23 | $14,562.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $87,274.24
| Facility | | $55.00 | $2,446.00 | $87,274.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,271.74 / $9,761.90 / $34,235.76
| Professional | | $3,271.74 | $9,761.90 | $34,235.76 |
- 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
- $3,014.89 / $7,595.72 / $16,236.19
| Professional | | $3,014.89 | $7,595.72 | $16,236.19 |