- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $3,363.00 / $4,806.64
| Facility | | $2,663.12 | $3,363.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,416.70 / $3,866.18 / $5,566.25
| Professional | | $3,416.70 | $3,866.18 | $5,566.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,800.00 / $55,044.96
| Facility | | $822.00 | $2,800.00 | $55,044.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,908.43 / $6,611.02 / $26,031.20
| Professional | | $3,908.43 | $6,611.02 | $26,031.20 |
- 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
- $2,950.68 / $6,197.29 / $12,689.01
| Professional | | $2,950.68 | $6,197.29 | $12,689.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $4,618.00 / $7,624.58
| Facility | | $300.00 | $4,618.00 | $7,624.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,109.95 / $5,193.41 / $8,488.79
| Professional | | $4,109.95 | $5,193.41 | $8,488.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,553.10 / $8,914.99 / $11,044.42
| Professional | | $4,553.10 | $8,914.99 | $11,044.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,800.00 / $55,044.96
| Facility | | $822.00 | $2,800.00 | $55,044.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,231.16 / $6,727.45 / $26,031.20
| Professional | | $4,231.16 | $6,727.45 | $26,031.20 |
- 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
- $4,065.36 / $5,923.62 / $14,893.93
| Professional | | $4,065.36 | $5,923.62 | $14,893.93 |