- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $2,563.98 / $2,852.55
| Facility | | $1,150.00 | $2,563.98 | $2,852.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.40 / $1,150.00 / $1,441.44
| Professional | | $842.40 | $1,150.00 | $1,441.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.57 / $1,628.64 / $4,446.00
| Facility | | $691.57 | $1,628.64 | $4,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.07 / $936.00 / $3,514.71
| Professional | | $469.07 | $936.00 | $3,514.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.64 / $2,127.33 / $3,719.10
| Facility | | $1,487.64 | $2,127.33 | $3,719.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.12 / $861.12 / $926.64
| Professional | | $861.12 | $861.12 | $926.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.40 / $669.24 / $1,824.83
| Facility | | $608.40 | $669.24 | $1,824.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.00 / $841.95 / $4,176.52
| Professional | | $468.00 | $841.95 | $4,176.52 |
- 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
- $1,350.77 / $1,350.77 / $1,589.14
| Professional | | $1,350.77 | $1,350.77 | $1,589.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.00 / $936.00 / $2,864.16
| Professional | | $936.00 | $936.00 | $2,864.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.64 / $4,446.00 / $4,446.00
| Facility | | $1,628.64 | $4,446.00 | $4,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.20 / $561.60 / $4,680.00
| Professional | | $421.20 | $561.60 | $4,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.12 / $561.60 / $1,784.08
| Professional | | $393.12 | $561.60 | $1,784.08 |