- 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
- $3,969.17 / $4,712.92 / $6,983.89
| Professional | | $3,969.17 | $4,712.92 | $6,983.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,372.00 / $61,316.50
| Facility | | $55.00 | $3,372.00 | $61,316.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,672.77 / $8,913.92 / $33,095.04
| Professional | | $4,672.77 | $8,913.92 | $33,095.04 |
- 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
- $3,458.40 / $7,757.87 / $16,082.13
| Professional | | $3,458.40 | $7,757.87 | $16,082.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,585.00 / $8,090.00
| Facility | | $300.00 | $5,585.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,246.94 / $6,630.13 / $9,739.43
| Professional | | $5,246.94 | $6,630.13 | $9,739.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,799.12 / $11,350.13 / $14,020.74
| Professional | | $5,799.12 | $11,350.13 | $14,020.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $61,316.50
| Facility | | $55.00 | $2,446.00 | $61,316.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,030.14 / $9,277.99 / $33,095.04
| Professional | | $5,030.14 | $9,277.99 | $33,095.04 |
- 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
- $4,871.16 / $6,839.34 / $15,916.53
| Professional | | $4,871.16 | $6,839.34 | $15,916.53 |