- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.50 / $5,502.90 / $7,177.92
| Facility | | $2,476.50 | $5,502.90 | $7,177.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,167.08 / $1,462.50 / $1,515.21
| Professional | | $1,167.08 | $1,462.50 | $1,515.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,145.00 / $4,527.89 / $9,262.50
| Facility | | $2,145.00 | $4,527.89 | $9,262.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.00 / $1,950.00 / $7,732.98
| Professional | | $1,053.00 | $1,950.00 | $7,732.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.00 / $2,788.50 / $4,875.00
| Facility | | $1,950.00 | $2,788.50 | $4,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.30 / $1,408.94 / $3,992.63
| Facility | | $1,317.30 | $1,408.94 | $3,992.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.96 / $2,374.96 / $2,845.47
| Professional | | $2,374.96 | $2,374.96 | $2,845.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,813.55 / $2,813.55 / $3,310.06
| Professional | | $2,813.55 | $2,813.55 | $3,310.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $5,019.30
| Professional | | $1,950.00 | $1,950.00 | $5,019.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,393.00 / $9,262.50 / $9,262.50
| Facility | | $3,393.00 | $9,262.50 | $9,262.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.00 / $1,170.00 / $9,711.00
| Professional | | $1,053.00 | $1,170.00 | $9,711.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.00 / $1,170.00 / $3,627.23
| Professional | | $1,053.00 | $1,170.00 | $3,627.23 |