- 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
- $3,577.06 / $4,197.83 / $5,842.87
| Professional | | $3,577.06 | $4,197.83 | $5,842.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,082.24 / $37,896.32
| Facility | | $55.00 | $3,082.24 | $37,896.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,072.10 / $7,853.38 / $32,765.58
| Professional | | $4,072.10 | $7,853.38 | $32,765.58 |
- 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
- $2,651.81 / $6,881.28 / $14,477.60
| Professional | | $2,651.81 | $6,881.28 | $14,477.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,165.13 / $8,090.00
| Facility | | $300.00 | $5,165.13 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,703.96 / $5,944.00 / $8,731.53
| Professional | | $4,703.96 | $5,944.00 | $8,731.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,199.87 / $10,181.35 / $13,088.07
| Professional | | $5,199.87 | $10,181.35 | $13,088.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $37,896.32
| Facility | | $55.00 | $2,446.00 | $37,896.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,454.18 / $8,333.08 / $32,765.58
| Professional | | $4,454.18 | $8,333.08 | $32,765.58 |
- 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
- $4,181.06 / $5,930.37 / $14,295.60
| Professional | | $4,181.06 | $5,930.37 | $14,295.60 |