- 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
- $3,612.68 / $4,244.33 / $6,370.20
| Professional | | $3,612.68 | $4,244.33 | $6,370.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,117.21 / $55,692.84
| Facility | | $55.00 | $3,117.21 | $55,692.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,247.67 / $7,988.76 / $30,072.24
| Professional | | $4,247.67 | $7,988.76 | $30,072.24 |
- 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
- $3,000.49 / $7,035.09 / $14,651.84
| Professional | | $3,000.49 | $7,035.09 | $14,651.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,237.09 / $8,090.00
| Facility | | $300.00 | $5,237.09 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,769.49 / $6,026.81 / $8,853.17
| Professional | | $4,769.49 | $6,026.81 | $8,853.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,268.28 / $10,312.00 / $12,738.35
| Professional | | $5,268.28 | $10,312.00 | $12,738.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $55,692.84
| Facility | | $55.00 | $2,446.00 | $55,692.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,566.14 / $8,412.04 / $30,072.24
| Professional | | $4,566.14 | $8,412.04 | $30,072.24 |
- 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
- $4,382.25 / $6,220.41 / $15,983.96
| Professional | | $4,382.25 | $6,220.41 | $15,983.96 |