- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,667.25 / $2,874.30 / $6,006.00
| Facility | | $1,667.25 | $2,874.30 | $6,006.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.00 / $1,579.50 / $1,667.25
| Professional | | $1,365.00 | $1,579.50 | $1,667.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $1,409.85 / $17,491.50
| Facility | | $59.30 | $1,409.85 | $17,491.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,281.50 / $2,730.00 / $3,451.50
| Facility | | $2,281.50 | $2,730.00 | $3,451.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.43 / $2,076.75 / $5,895.43
| Facility | | $1,804.43 | $2,076.75 | $5,895.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $584.89 / $1,999.33
| Professional | | $325.33 | $584.89 | $1,999.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $2,964.00
| Professional | | $1,950.00 | $1,950.00 | $2,964.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.00 / $1,950.00 / $1,950.00
| Professional | | $1,950.00 | $1,950.00 | $1,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.25 / $1,267.50 / $3,186.37
| Professional | | $887.25 | $1,267.50 | $3,186.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.00 / $1,170.00 / $1,657.50
| Professional | | $1,170.00 | $1,170.00 | $1,657.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,740.28 / $3,270.15 / $5,372.93
| Facility | | $1,740.28 | $3,270.15 | $5,372.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.53 / $2,374.96 / $2,845.47
| Professional | | $2,240.53 | $2,374.96 | $2,845.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $1,755.00 / $2,223.00
| Facility | | $1,170.00 | $1,755.00 | $2,223.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $1,053.00 / $2,242.50
| Professional | | $737.10 | $1,053.00 | $2,242.50 |