- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,499.00 / $5,923.00
| Facility | | $1,375.00 | $2,499.00 | $5,923.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.29 / $593.69 / $2,599.00
| Professional | | $583.29 | $593.69 | $2,599.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $4,589.00 / $6,006.00
| Facility | | $3,671.00 | $4,589.00 | $6,006.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.99 / $672.55 / $967.93
| Professional | | $555.99 | $672.55 | $967.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,741.63 / $1,741.63 / $1,741.63
| Facility | | $1,741.63 | $1,741.63 | $1,741.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.22 / $659.97 / $964.92
| Professional | | $474.22 | $659.97 | $964.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.26 / $668.30 / $2,248.98
| Professional | | $9.26 | $668.30 | $2,248.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.18 / $3,811.73 / $3,811.73
| Facility | | $1,799.18 | $3,811.73 | $3,811.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $549.86 / $2,698.77
| Professional | | $6.30 | $549.86 | $2,698.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.00 / $3,000.00 / $9,042.00
| Facility | | $1,642.00 | $3,000.00 | $9,042.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.30 / $685.96 / $965.11
| Professional | | $551.30 | $685.96 | $965.11 |