- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.00 / $1,208.40 / $2,166.00
| Facility | | $532.00 | $1,208.40 | $2,166.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.80 / $499.70 / $646.00
| Professional | | $402.80 | $499.70 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $1,976.00
| Facility | | $760.00 | $760.00 | $1,976.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.33 / $325.33 / $1,026.00
| Professional | | $325.33 | $325.33 | $1,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $760.00 / $760.00
| Facility | | $760.00 | $760.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.79 / $760.00 / $760.00
| Professional | | $554.79 | $760.00 | $760.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.82 / $1,539.03 / $1,972.11
| Facility | | $755.82 | $1,539.03 | $1,972.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.00 / $1,109.33 / $3,663.20
| Professional | | $608.00 | $1,109.33 | $3,663.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $912.00 / $1,710.00
| Facility | | $294.00 | $912.00 | $1,710.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.00 / $1,026.00 / $1,649.20
| Professional | | $798.00 | $1,026.00 | $1,649.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.00 / $760.00 / $1,378.10
| Professional | | $646.00 | $760.00 | $1,378.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.00 / $1,854.25 / $1,972.11
| Facility | | $741.00 | $1,854.25 | $1,972.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $570.00 / $1,748.00
| Professional | | $494.00 | $570.00 | $1,748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $456.00 / $1,151.83
| Professional | | $319.20 | $456.00 | $1,151.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.00 / $873.98 / $873.98
| Facility | | $760.00 | $873.98 | $873.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.00 / $760.00 / $913.46
| Professional | | $646.00 | $760.00 | $913.46 |