- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.65 / $903.00 / $7,362.00
| Facility | | $397.65 | $903.00 | $7,362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.65 / $420.95 / $806.43
| Professional | | $397.65 | $420.95 | $806.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.34 / $1,920.34 / $1,948.36
| Facility | | $1,920.34 | $1,920.34 | $1,948.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.64 / $631.16 / $1,105.99
| Professional | | $359.64 | $631.16 | $1,105.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,393.27
| Facility | | $395.75 | $395.75 | $2,393.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.94 / $561.78 / $1,032.77
| Professional | | $410.94 | $561.78 | $1,032.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.65 / $513.54 / $796.99
| Facility | | $397.65 | $513.54 | $796.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $554.00 / $554.00
| Professional | | $378.00 | $554.00 | $554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $537.60 / $1,167.00
| Professional | | $5.00 | $537.60 | $1,167.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.47 / $481.85 / $982.61
| Professional | | $346.47 | $481.85 | $982.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,263.62 / $7,909.30 / $12,000.00
| Facility | | $2,263.62 | $7,909.30 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,589.56 / $6,589.56 / $6,589.56
| Professional | | $6,589.56 | $6,589.56 | $6,589.56 |