- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.56 / $2,010.56 / $2,111.09
| Facility | | $2,010.56 | $2,010.56 | $2,111.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.00 / $921.82 / $921.82
| Professional | | $581.00 | $921.82 | $921.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.00 / $1,044.38 / $1,436.00
| Professional | | $938.00 | $1,044.38 | $1,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.00 / $795.00 / $2,228.65
| Facility | | $155.00 | $795.00 | $2,228.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $568.92 / $828.00
| Professional | | $145.00 | $568.92 | $828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.56 / $2,010.56 / $2,010.56
| Facility | | $2,010.56 | $2,010.56 | $2,010.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $775.00 / $1,336.00
| Professional | | $200.00 | $775.00 | $1,336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.25 / $1,547.25 / $1,547.25
| Facility | | $1,547.25 | $1,547.25 | $1,547.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.00 / $795.00 / $2,228.65
| Facility | | $155.00 | $795.00 | $2,228.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $630.00 / $828.00
| Professional | | $145.00 | $630.00 | $828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.90 / $339.90 / $838.98
| Professional | | $339.90 | $339.90 | $838.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.56 / $877.56 / $877.56
| Facility | | $877.56 | $877.56 | $877.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.55 / $811.54 / $1,795.00
| Professional | | $623.55 | $811.54 | $1,795.00 |