- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,663.12 / $4,712.00
| Facility | | $750.00 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.88 / $817.87 / $2,493.60
| Professional | | $460.88 | $817.87 | $2,493.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $4,874.70 / $11,977.15
| Facility | | $941.10 | $4,874.70 | $11,977.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.21 / $1,383.24 / $6,251.44
| Professional | | $791.21 | $1,383.24 | $6,251.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.89 / $1,685.23 / $2,217.23
| Professional | | $1,222.89 | $1,685.23 | $2,217.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.27 / $1,133.27 / $1,357.79
| Professional | | $1,133.27 | $1,133.27 | $1,357.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,844.32 / $8,090.00
| Facility | | $300.00 | $1,844.32 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.99 / $1,291.02 / $1,908.87
| Professional | | $1,018.99 | $1,291.02 | $1,908.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.16 / $2,136.17 / $2,695.23
| Professional | | $1,082.16 | $2,136.17 | $2,695.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,874.70 / $11,977.15
| Facility | | $1,485.00 | $4,874.70 | $11,977.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.16 / $1,291.02 / $6,251.44
| Professional | | $765.16 | $1,291.02 | $6,251.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.88 / $1,152.53 / $2,669.16
| Professional | | $724.88 | $1,152.53 | $2,669.16 |