- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $3,061.00 / $5,011.00
| Facility | | $1,924.00 | $3,061.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,268.87 / $4,950.78 / $7,706.16
| Professional | | $4,268.87 | $4,950.78 | $7,706.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,390.00 / $41,732.00
| Facility | | $55.00 | $3,390.00 | $41,732.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,781.43 / $9,148.91 / $34,397.28
| Professional | | $4,781.43 | $9,148.91 | $34,397.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,126.17 / $9,083.45 / $12,304.96
| Professional | | $6,126.17 | $9,083.45 | $12,304.96 |
- 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
- $1,370.93 / $7,994.11 / $16,761.75
| Professional | | $1,370.93 | $7,994.11 | $16,761.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $5,690.17 / $8,090.00
| Facility | | $300.00 | $5,690.17 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,441.23 / $6,875.62 / $10,100.06
| Professional | | $5,441.23 | $6,875.62 | $10,100.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,034.23 / $11,815.02 / $14,613.63
| Professional | | $6,034.23 | $11,815.02 | $14,613.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $43,923.68
| Facility | | $55.00 | $2,446.00 | $43,923.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,218.92 / $9,746.95 / $34,397.28
| Professional | | $5,218.92 | $9,746.95 | $34,397.28 |
- 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
- $5,143.88 / $7,147.49 / $15,667.48
| Professional | | $5,143.88 | $7,147.49 | $15,667.48 |