- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,580.00 / $3,525.48 / $3,922.26
| Facility | | $1,580.00 | $3,525.48 | $3,922.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,042.47 / $1,580.00 / $1,981.98
| Professional | | $1,042.47 | $1,580.00 | $1,981.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.91 / $2,239.38 / $6,113.25
| Facility | | $950.91 | $2,239.38 | $6,113.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.76 / $1,287.00 / $4,832.72
| Professional | | $617.76 | $1,287.00 | $4,832.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,045.58 / $2,925.18 / $5,113.95
| Facility | | $2,045.58 | $2,925.18 | $5,113.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.04 / $1,184.04 / $1,184.04
| Professional | | $1,184.04 | $1,184.04 | $1,184.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.55 / $920.21 / $2,509.15
| Facility | | $836.55 | $920.21 | $2,509.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.50 / $1,157.77 / $5,742.91
| Professional | | $643.50 | $1,157.77 | $5,742.91 |
- 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
- $1,857.19 / $1,857.19 / $2,184.92
| Professional | | $1,857.19 | $1,857.19 | $2,184.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.00 / $1,287.00 / $4,185.00
| Professional | | $1,287.00 | $1,287.00 | $4,185.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.38 / $6,113.25 / $6,113.25
| Facility | | $2,239.38 | $6,113.25 | $6,113.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.15 / $772.20 / $6,435.00
| Professional | | $579.15 | $772.20 | $6,435.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $772.20 / $1,930.50
| Professional | | $514.79 | $772.20 | $1,930.50 |