- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,247.79 / $4,806.64
| Facility | | $2,663.12 | $3,247.79 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,829.93 / $3,247.79 / $4,674.72
| Professional | | $2,829.93 | $3,247.79 | $4,674.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,800.00 / $46,913.60
| Facility | | $822.00 | $2,800.00 | $46,913.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,324.87 / $5,615.51 / $22,171.76
| Professional | | $3,324.87 | $5,615.51 | $22,171.76 |
- 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
- $2,517.40 / $5,222.34 / $10,834.06
| Professional | | $2,517.40 | $5,222.34 | $10,834.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,973.57 / $6,679.00
| Facility | | $300.00 | $3,973.57 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,507.44 / $4,432.06 / $7,131.02
| Professional | | $3,507.44 | $4,432.06 | $7,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,881.37 / $7,586.38 / $9,371.41
| Professional | | $3,881.37 | $7,586.38 | $9,371.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,800.00 / $46,913.60
| Facility | | $822.00 | $2,800.00 | $46,913.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,564.16 / $5,700.81 / $22,171.76
| Professional | | $3,564.16 | $5,700.81 | $22,171.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,413.30 / $4,892.97 / $11,558.21
| Professional | | $3,413.30 | $4,892.97 | $11,558.21 |