- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.00 / $2,300.00 / $2,300.00
| Facility | | $2,300.00 | $2,300.00 | $2,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,300.00 / $4,507.87 / $8,680.10
| Professional | | $2,300.00 | $4,507.87 | $8,680.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,414.00 / $8,358.04
| Facility | | $789.00 | $3,414.00 | $8,358.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.10 / $4,215.85 / $17,653.20
| Professional | | $2,281.10 | $4,215.85 | $17,653.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,883.03 / $5,105.85 / $6,443.33
| Professional | | $2,883.03 | $5,105.85 | $6,443.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,752.74 / $5,024.22 / $6,851.29
| Professional | | $2,752.74 | $5,024.22 | $6,851.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,504.00 / $8,090.00
| Facility | | $300.00 | $3,504.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,517.44 / $2,825.34 / $4,457.76
| Professional | | $1,517.44 | $2,825.34 | $4,457.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,124.43 / $6,193.87 / $7,864.19
| Professional | | $3,124.43 | $6,193.87 | $7,864.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,533.91 / $3,807.15 / $4,040.12
| Professional | | $3,533.91 | $3,807.15 | $4,040.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $14,176.08
| Facility | | $55.00 | $2,854.00 | $14,176.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,200.00 / $4,380.46 / $17,653.20
| Professional | | $2,200.00 | $4,380.46 | $17,653.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,148.69 / $3,349.75 / $6,889.73
| Professional | | $2,148.69 | $3,349.75 | $6,889.73 |