- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.85 / $416.79 / $669.17
| Professional | | $385.85 | $416.79 | $669.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $9,039.00
| Facility | | $1,061.00 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.57 / $738.86 / $6,589.56
| Professional | | $438.57 | $738.86 | $6,589.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.05 / $402.07 / $608.54
| Professional | | $402.05 | $402.07 | $608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.63 / $696.22 / $1,164.20
| Professional | | $409.63 | $696.22 | $1,164.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.79 / $894.12 / $6,679.00
| Facility | | $410.79 | $894.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.38 / $571.00 / $786.83
| Professional | | $471.38 | $571.00 | $786.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.45 / $1,002.00 / $1,321.80
| Professional | | $505.45 | $1,002.00 | $1,321.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $12,000.00
| Facility | | $1,902.00 | $3,997.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.00 / $771.59 / $6,589.56
| Professional | | $419.00 | $771.59 | $6,589.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.66 / $627.29 / $1,272.22
| Professional | | $416.66 | $627.29 | $1,272.22 |