- 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
- $1,246.40 / $1,420.89 / $2,343.23
| Professional | | $1,246.40 | $1,420.89 | $2,343.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.20 / $1,170.40 / $2,090.00
| Facility | | $98.20 | $1,170.40 | $2,090.00 |
- 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
- $508.93 / $879.32 / $1,921.66
| Facility | | $508.93 | $879.32 | $1,921.66 |
- 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 / $1,695.95
| Facility | | $608.00 | $912.00 | $1,695.95 |
- 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 / $332.10 / $1,830.00
| Professional | | $319.20 | $332.10 | $1,830.00 |