- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.65 / $2,415.00 / $3,774.36
| Facility | | $729.65 | $2,415.00 | $3,774.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.25 / $729.65 / $1,617.00
| Professional | | $698.25 | $729.65 | $1,617.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.80 / $1,827.00 / $4,987.50
| Facility | | $775.80 | $1,827.00 | $4,987.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.41 / $1,050.00 / $3,942.78
| Professional | | $625.41 | $1,050.00 | $3,942.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,669.23 / $2,387.00 / $4,173.08
| Facility | | $1,669.23 | $2,387.00 | $4,173.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.00 / $987.00 / $987.00
| Professional | | $987.00 | $987.00 | $987.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.50 / $819.00 / $2,388.75
| Facility | | $682.50 | $819.00 | $2,388.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.10 / $1,206.36 / $4,686.32
| Professional | | $630.10 | $1,206.36 | $4,686.32 |
- 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
- $1,515.07 / $1,515.07 / $1,782.43
| Professional | | $1,515.07 | $1,515.07 | $1,782.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.00 / $1,050.00 / $3,251.75
| Professional | | $1,050.00 | $1,050.00 | $3,251.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,827.00 / $4,987.50 / $4,987.50
| Facility | | $1,827.00 | $4,987.50 | $4,987.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.50 / $630.00 / $5,250.00
| Professional | | $472.50 | $630.00 | $5,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.00 / $630.00 / $2,170.14
| Professional | | $441.00 | $630.00 | $2,170.14 |