- 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
- $1,957.57 / $3,217.50 / $3,646.50
| Professional | | $1,957.57 | $3,217.50 | $3,646.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $35,856.16
| Facility | | $55.00 | $2,854.00 | $35,856.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,081.64 / $3,524.81 / $14,090.00
| Professional | | $2,081.64 | $3,524.81 | $14,090.00 |
- 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
- $619.67 / $3,991.69 / $7,878.83
| Professional | | $619.67 | $3,991.69 | $7,878.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $3,343.00 / $6,679.00
| Facility | | $578.00 | $3,343.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,637.84 / $3,313.14 / $4,896.38
| Professional | | $2,637.84 | $3,313.14 | $4,896.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,584.98 / $5,061.41 / $6,265.55
| Professional | | $2,584.98 | $5,061.41 | $6,265.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $35,856.16
| Facility | | $55.00 | $2,446.00 | $35,856.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.73 / $3,524.97 / $14,090.00
| Professional | | $2,188.73 | $3,524.97 | $14,090.00 |
- 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
- $2,067.30 / $3,179.36 / $6,450.01
| Professional | | $2,067.30 | $3,179.36 | $6,450.01 |