- 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
- $2,194.08 / $2,600.00 / $6,269.59
| Professional | | $2,194.08 | $2,600.00 | $6,269.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,414.00 / $8,957.91
| Facility | | $789.00 | $3,414.00 | $8,957.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,435.34 / $4,581.31 / $18,919.91
| Professional | | $2,435.34 | $4,581.31 | $18,919.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,433.69 / $4,727.59 / $8,150.33
| Professional | | $3,433.69 | $4,727.59 | $8,150.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,949.62 / $5,363.01 / $7,343.03
| Professional | | $2,949.62 | $5,363.01 | $7,343.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,683.47 / $8,090.00
| Facility | | $300.00 | $3,683.47 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.14 / $3,027.74 / $4,777.09
| Professional | | $1,626.14 | $3,027.74 | $4,777.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,348.48 / $6,638.03 / $8,428.12
| Professional | | $3,348.48 | $6,638.03 | $8,428.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,084.73 / $4,298.89 / $4,408.01
| Professional | | $4,084.73 | $4,298.89 | $4,408.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $20,257.20
| Facility | | $55.00 | $2,854.00 | $20,257.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,429.94 / $4,742.72 / $18,919.91
| Professional | | $2,429.94 | $4,742.72 | $18,919.91 |
- 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
- $2,297.40 / $3,576.20 / $7,355.48
| Professional | | $2,297.40 | $3,576.20 | $7,355.48 |