- 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
- $3,360.13 / $3,837.62 / $5,719.93
| Professional | | $3,360.13 | $3,837.62 | $5,719.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $55,777.28
| Facility | | $55.00 | $2,854.00 | $55,777.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,724.20 / $6,994.55 / $26,342.40
| Professional | | $2,724.20 | $6,994.55 | $26,342.40 |
- 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
- $2,022.50 / $6,195.26 / $12,808.01
| Professional | | $2,022.50 | $6,195.26 | $12,808.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $4,618.00 / $7,693.28
| Facility | | $300.00 | $4,618.00 | $7,693.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,154.24 / $5,249.36 / $7,711.13
| Professional | | $4,154.24 | $5,249.36 | $7,711.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,610.87 / $9,028.08 / $11,188.92
| Professional | | $4,610.87 | $9,028.08 | $11,188.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $67,163.52
| Facility | | $55.00 | $2,446.00 | $67,163.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,788.10 / $7,448.70 / $26,342.40
| Professional | | $2,788.10 | $7,448.70 | $26,342.40 |
- 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
- $2,578.80 / $5,398.31 / $12,717.36
| Professional | | $2,578.80 | $5,398.31 | $12,717.36 |