- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,096.25 / $4,088.00
| Facility | | $988.00 | $2,096.25 | $4,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $304.95 / $405.00
| Professional | | $150.07 | $304.95 | $405.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.41 / $1,790.00 / $3,445.00
| Facility | | $532.41 | $1,790.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.92 / $409.18 / $1,509.92
| Professional | | $215.92 | $409.18 | $1,509.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.12 / $248.12 / $248.12
| Professional | | $248.12 | $248.12 | $248.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.71 / $172.71 / $217.17
| Professional | | $172.71 | $172.71 | $217.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.86 / $257.32 / $8,090.00
| Facility | | $162.86 | $257.32 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.88 / $226.38 / $335.04
| Professional | | $186.88 | $226.38 | $335.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.73 / $495.22 / $651.86
| Professional | | $261.73 | $495.22 | $651.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,013.57 / $8,013.57 / $8,532.44
| Facility | | $8,013.57 | $8,013.57 | $8,532.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.41 / $1,790.00 / $3,445.00
| Facility | | $532.41 | $1,790.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.92 / $392.93 / $1,509.92
| Professional | | $215.92 | $392.93 | $1,509.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.11 / $354.48 / $650.54
| Professional | | $213.11 | $354.48 | $650.54 |