- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,663.12 / $4,410.00
| Facility | | $1,758.00 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,909.69 / $2,200.50 / $3,124.60
| Professional | | $1,909.69 | $2,200.50 | $3,124.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $14,417.06
| Facility | | $55.00 | $2,733.00 | $14,417.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,304.34 / $4,158.64 / $17,183.28
| Professional | | $2,304.34 | $4,158.64 | $17,183.28 |
- 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
- $1,602.73 / $3,633.71 / $7,636.28
| Professional | | $1,602.73 | $3,633.71 | $7,636.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,237.17 / $6,679.00
| Facility | | $300.00 | $3,237.17 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,472.31 / $3,124.05 / $4,589.13
| Professional | | $2,472.31 | $3,124.05 | $4,589.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,728.35 / $5,342.11 / $6,867.26
| Professional | | $2,728.35 | $5,342.11 | $6,867.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $17,409.34
| Facility | | $55.00 | $2,446.00 | $17,409.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,409.35 / $4,395.97 / $17,183.28
| Professional | | $2,409.35 | $4,395.97 | $17,183.28 |
- 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
- $2,304.34 / $3,227.36 / $7,561.17
| Professional | | $2,304.34 | $3,227.36 | $7,561.17 |