- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.00 / $4,485.00 / $5,942.82
| Facility | | $1,365.00 | $4,485.00 | $5,942.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,282.13 / $1,365.00 / $1,579.50
| Professional | | $1,282.13 | $1,365.00 | $1,579.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,145.00 / $4,974.47 / $7,124.72
| Facility | | $2,145.00 | $4,974.47 | $7,124.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.00 / $1,950.00 / $7,732.98
| Professional | | $1,170.00 | $1,950.00 | $7,732.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,280.18 / $1,344.19 / $3,132.07
| Facility | | $1,280.18 | $1,344.19 | $3,132.07 |
- 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 / $4,049.76
| Professional | | $1,950.00 | $1,950.00 | $4,049.76 |
- 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
- $1,170.00 / $1,170.00 / $9,711.00
| Professional | | $1,170.00 | $1,170.00 | $9,711.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,950.00 / $2,340.00
| Facility | | $1,755.00 | $1,950.00 | $2,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.00 / $1,170.00 / $3,412.50
| Professional | | $1,170.00 | $1,170.00 | $3,412.50 |