- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,895.80 / $4,806.64
| Facility | | $2,663.12 | $2,895.80 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,532.92 / $3,014.04 / $4,533.22
| Professional | | $2,532.92 | $3,014.04 | $4,533.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $27,115.76
| Facility | | $55.00 | $2,854.00 | $27,115.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,156.92 / $5,669.60 / $21,233.36
| Professional | | $2,156.92 | $5,669.60 | $21,233.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,793.24 / $5,624.35 / $7,619.06
| Professional | | $3,793.24 | $5,624.35 | $7,619.06 |
- 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
- $1,459.81 / $4,940.22 / $10,151.35
| Professional | | $1,459.81 | $4,940.22 | $10,151.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,810.00 / $6,679.00
| Facility | | $300.00 | $3,810.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,363.06 / $4,249.62 / $6,242.54
| Professional | | $3,363.06 | $4,249.62 | $6,242.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,722.44 / $7,288.54 / $9,021.66
| Professional | | $3,722.44 | $7,288.54 | $9,021.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $27,115.76
| Facility | | $55.00 | $2,446.00 | $27,115.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,263.35 / $5,992.03 / $21,233.36
| Professional | | $2,263.35 | $5,992.03 | $21,233.36 |
- 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
- $2,132.19 / $4,458.63 / $9,622.87
| Professional | | $2,132.19 | $4,458.63 | $9,622.87 |