- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,985.76 / $5,458.70
| Facility | | $570.00 | $1,985.76 | $5,458.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.20 / $630.79 / $646.00
| Professional | | $414.20 | $630.79 | $646.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $3,807.60
| Facility | | $244.00 | $614.00 | $3,807.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $396.78 / $735.43
| Professional | | $336.26 | $396.78 | $735.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $1,003.20 / $6,817.20
| Facility | | $59.40 | $1,003.20 | $6,817.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.80 / $494.00 / $1,235.25
| Professional | | $345.80 | $494.00 | $1,235.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.41 / $1,274.52 / $2,544.10
| Facility | | $501.41 | $1,274.52 | $2,544.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $836.00 / $1,026.00
| Professional | | $760.00 | $836.00 | $1,026.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.00 / $874.00 / $1,451.60
| Professional | | $684.00 | $874.00 | $1,451.60 |
- 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
- $3,784.80 / $3,784.80 / $5,700.00
| Professional | | $3,784.80 | $3,784.80 | $5,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.00 / $912.00 / $2,016.51
| Facility | | $608.00 | $912.00 | $2,016.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $760.00 / $836.00 / $1,140.00
| Professional | | $760.00 | $836.00 | $1,140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $342.00 / $2,117.82
| Professional | | $319.20 | $342.00 | $2,117.82 |