- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.67 / $3,964.00 / $8,427.00
| Facility | | $1,043.67 | $3,964.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.19 / $2,849.57 / $6,146.40
| Professional | | $307.19 | $2,849.57 | $6,146.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $64,999.35 / $64,999.35
| Professional | | $55,249.45 | $64,999.35 | $64,999.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $800.00 / $2,269.00
| Facility | | $495.00 | $800.00 | $2,269.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55,249.45 / $55,249.45 / $55,249.45
| Professional | | $55,249.45 | $55,249.45 | $55,249.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.17 / $4,061.85 / $4,246.64
| Facility | | $502.17 | $4,061.85 | $4,246.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.00 / $2,769.90 / $2,904.24
| Professional | | $236.00 | $2,769.90 | $2,904.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,013.00 / $4,761.00 / $8,427.00
| Facility | | $1,013.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.50 / $2,849.57 / $7,197.00
| Professional | | $441.50 | $2,849.57 | $7,197.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $800.00 / $2,269.00
| Facility | | $495.00 | $800.00 | $2,269.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.00 / $1,102.00 / $1,102.00
| Professional | | $1,102.00 | $1,102.00 | $1,102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.00 / $1,106.00 / $3,742.00
| Facility | | $316.00 | $1,106.00 | $3,742.00 |