- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $2,303.00 / $7,602.00
| Facility | | $575.00 | $2,303.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.97 / $524.66 / $655.99
| Professional | | $224.97 | $524.66 | $655.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.00 / $143.00 / $623.00
| Facility | | $101.00 | $143.00 | $623.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.51 / $775.45 / $1,249.96
| Professional | | $568.51 | $775.45 | $1,249.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.48 / $1,887.62 / $3,733.31
| Facility | | $1,589.48 | $1,887.62 | $3,733.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,065.12 / $5,507.20 / $6,414.98
| Professional | | $5,065.12 | $5,507.20 | $6,414.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.36 / $734.53 / $1,291.26
| Professional | | $538.36 | $734.53 | $1,291.26 |