- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $1,748.00 / $2,316.17
| Facility | | $532.00 | $1,748.00 | $2,316.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.70 / $532.00 / $615.60
| Professional | | $499.70 | $532.00 | $615.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.00 / $1,938.77 / $2,776.81
| Facility | | $836.00 | $1,938.77 | $2,776.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $760.00 / $3,013.88
| Professional | | $456.00 | $760.00 | $3,013.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,208.09 / $1,727.58 / $3,020.25
| Facility | | $1,208.09 | $1,727.58 | $3,020.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.20 / $699.20 / $699.20
| Professional | | $699.20 | $699.20 | $699.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.94 / $592.79 / $1,729.00
| Facility | | $498.94 | $592.79 | $1,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.60 / $925.90 / $1,109.33
| Professional | | $444.60 | $925.90 | $1,109.33 |
- 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
- $1,096.84 / $1,096.84 / $1,290.42
| Professional | | $1,096.84 | $1,096.84 | $1,290.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $2,353.64
| Professional | | $760.00 | $760.00 | $2,353.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.40 / $3,610.00 / $3,610.00
| Facility | | $1,322.40 | $3,610.00 | $3,610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.00 / $456.00 / $3,800.00
| Professional | | $456.00 | $456.00 | $3,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $456.00 / $1,448.61
| Professional | | $319.20 | $456.00 | $1,448.61 |