- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,693.00
| Facility | | $1,485.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.10 / $877.65 / $1,539.10
| Professional | | $639.10 | $877.65 | $1,539.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,006.00 / $12,500.00
| Facility | | $818.35 | $3,006.00 | $12,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.61 / $1,653.05 / $12,630.10
| Professional | | $869.61 | $1,653.05 | $12,630.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.98 / $1,063.14 / $1,910.45
| Professional | | $675.98 | $1,063.14 | $1,910.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.66 / $1,694.17 / $3,063.14
| Professional | | $1,171.66 | $1,694.17 | $3,063.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,308.93 / $8,090.00
| Facility | | $300.00 | $1,308.93 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.53 / $1,178.04 / $2,118.12
| Professional | | $937.53 | $1,178.04 | $2,118.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.06 / $2,051.90 / $2,605.25
| Professional | | $1,035.06 | $2,051.90 | $2,605.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $12,500.00
| Facility | | $55.00 | $5,268.00 | $12,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.44 / $1,745.24 / $12,630.10
| Professional | | $1,059.44 | $1,745.24 | $12,630.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.00 / $1,280.46 / $2,924.20
| Professional | | $957.00 | $1,280.46 | $2,924.20 |