- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.00 / $4,106.00 / $9,969.75
| Facility | | $1,668.00 | $4,106.00 | $9,969.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.58 / $389.08 / $469.25
| Professional | | $265.58 | $389.08 | $469.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.00 / $3,263.00 / $4,636.00
| Facility | | $1,651.00 | $3,263.00 | $4,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.04 / $206.09 / $245.14
| Professional | | $87.04 | $206.09 | $245.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.62 / $440.62 / $7,289.38
| Facility | | $440.62 | $440.62 | $7,289.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.48 / $1,833.48 / $1,833.48
| Professional | | $1,833.48 | $1,833.48 | $1,833.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.61 / $535.61 / $535.61
| Professional | | $535.61 | $535.61 | $535.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.67 / $361.67 / $361.67
| Facility | | $361.67 | $361.67 | $361.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.67 / $522.62 / $821.16
| Professional | | $361.67 | $522.62 | $821.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.62 / $597.00 / $7,289.38
| Facility | | $440.62 | $597.00 | $7,289.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.48 / $1,833.48 / $1,833.48
| Professional | | $1,833.48 | $1,833.48 | $1,833.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.00 / $3,612.00 / $8,133.00
| Facility | | $1,269.00 | $3,612.00 | $8,133.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.71 / $454.87 / $1,061.02
| Professional | | $331.71 | $454.87 | $1,061.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.67 / $372.40 / $372.40
| Facility | | $361.67 | $372.40 | $372.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.40 / $372.40 / $781.24
| Professional | | $372.40 | $372.40 | $781.24 |