- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.50 / $3,737.50 / $4,952.35
| Facility | | $1,137.50 | $3,737.50 | $4,952.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.00 / $1,137.50 / $2,502.50
| Professional | | $975.00 | $1,137.50 | $2,502.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.64 / $2,827.50 / $7,718.75
| Facility | | $1,200.64 | $2,827.50 | $7,718.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.50 / $1,625.00 / $6,101.92
| Professional | | $892.50 | $1,625.00 | $6,101.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.32 / $3,476.58 / $6,457.25
| Facility | | $152.32 | $3,476.58 | $6,457.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,495.00 / $1,495.00 / $1,495.00
| Professional | | $1,495.00 | $1,495.00 | $1,495.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.25 / $1,161.88 / $3,168.12
| Facility | | $1,056.25 | $1,161.88 | $3,168.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.62 / $1,714.54 / $7,251.41
| Professional | | $950.62 | $1,714.54 | $7,251.41 |
- 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
- $2,344.94 / $2,344.94 / $2,758.75
| Professional | | $2,344.94 | $2,344.94 | $2,758.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,625.00 / $1,625.00 / $5,284.08
| Professional | | $1,625.00 | $1,625.00 | $5,284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,827.50 / $7,718.75 / $7,718.75
| Facility | | $2,827.50 | $7,718.75 | $7,718.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.25 / $975.00 / $8,125.00
| Professional | | $731.25 | $975.00 | $8,125.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.50 / $975.00 / $2,632.76
| Professional | | $682.50 | $975.00 | $2,632.76 |