- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.50 / $2,663.12 / $3,625.00
| Facility | | $431.50 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.80 / $431.50 / $912.90
| Professional | | $284.80 | $431.50 | $912.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.56 / $2,401.08 / $8,498.00
| Facility | | $828.56 | $2,401.08 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.81 / $789.66 / $2,505.52
| Professional | | $384.81 | $789.66 | $2,505.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $536.64 / $946.96
| Facility | | $412.80 | $536.64 | $946.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.41 / $782.00 / $1,637.90
| Professional | | $433.41 | $782.00 | $1,637.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.69 / $752.70 / $6,679.00
| Facility | | $348.69 | $752.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.25 / $766.17 / $1,057.61
| Professional | | $605.25 | $766.17 | $1,057.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.45 / $917.90 / $1,495.17
| Professional | | $437.45 | $917.90 | $1,495.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.13 / $999.25 / $3,889.36
| Professional | | $536.13 | $999.25 | $3,889.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.75 / $751.19 / $1,495.17
| Professional | | $406.75 | $751.19 | $1,495.17 |