- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.00 / $3,100.50 / $5,557.50
| Facility | | $1,365.00 | $3,100.50 | $5,557.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.50 / $1,282.13 / $1,657.50
| Professional | | $1,033.50 | $1,282.13 | $1,657.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,549.20 / $1,549.20 / $3,654.25
| Professional | | $1,549.20 | $1,549.20 | $3,654.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.00 / $4,119.38 / $7,019.45
| Facility | | $2,340.00 | $4,119.38 | $7,019.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.96 / $9,399.00 / $9,399.00
| Professional | | $2,374.96 | $9,399.00 | $9,399.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,340.00 / $4,387.50
| Facility | | $294.00 | $2,340.00 | $4,387.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.50 / $2,554.50 / $4,231.50
| Professional | | $2,047.50 | $2,554.50 | $4,231.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.50 / $1,950.00 / $3,535.92
| Professional | | $1,657.50 | $1,950.00 | $3,535.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $4,119.38 / $7,019.45
| Facility | | $555.00 | $4,119.38 | $7,019.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.50 / $2,106.00 / $4,485.00
| Professional | | $1,267.50 | $2,106.00 | $4,485.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,755.00 / $1,755.00 / $1,950.00
| Facility | | $1,755.00 | $1,755.00 | $1,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.00 / $1,170.00 / $3,061.21
| Professional | | $819.00 | $1,170.00 | $3,061.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.89 / $2,242.44 / $2,242.44
| Facility | | $2,060.89 | $2,242.44 | $2,242.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.50 / $2,060.89 / $2,351.35
| Professional | | $1,657.50 | $2,060.89 | $2,351.35 |