- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $1,331.10 / $16,733.00
| Facility | | $510.00 | $1,331.10 | $16,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.00 / $492.00 / $510.00
| Professional | | $450.00 | $492.00 | $510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.80 / $2,922.00 / $3,690.00
| Facility | | $2,278.80 | $2,922.00 | $3,690.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.00 / $240.00 / $390.00
| Professional | | $240.00 | $240.00 | $390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.00 / $552.00 / $1,076.40
| Professional | | $480.00 | $552.00 | $1,076.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.00 / $1,322.30 / $3,073.08
| Facility | | $390.00 | $1,322.30 | $3,073.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.09 / $731.09 / $875.93
| Professional | | $731.09 | $731.09 | $875.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $720.00 / $888.00
| Professional | | $600.00 | $720.00 | $888.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.00 / $600.00 / $1,020.00
| Facility | | $477.00 | $600.00 | $1,020.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.00 / $1,050.00 / $1,440.00
| Professional | | $822.00 | $1,050.00 | $1,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.00 / $665.88 / $1,113.96
| Facility | | $420.00 | $665.88 | $1,113.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.00 / $682.20 / $1,113.96
| Professional | | $420.00 | $682.20 | $1,113.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.00 / $333.00 / $690.00
| Professional | | $252.00 | $333.00 | $690.00 |