- 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
- $532.82 / $624.48 / $976.71
| Professional | | $532.82 | $624.48 | $976.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.50 / $3,110.00 / $7,887.32
| Facility | | $899.50 | $3,110.00 | $7,887.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.82 / $657.32 / $4,334.47
| Professional | | $382.82 | $657.32 | $4,334.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.88 / $989.14 / $1,666.74
| Professional | | $588.88 | $989.14 | $1,666.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.33 / $1,349.66 / $6,679.00
| Facility | | $424.33 | $1,349.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.92 / $572.85 / $903.82
| Professional | | $486.92 | $572.85 | $903.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.39 / $1,419.81 / $1,888.73
| Professional | | $750.39 | $1,419.81 | $1,888.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,897.00 / $9,651.74
| Facility | | $2,155.00 | $5,897.00 | $9,651.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.55 / $611.04 / $4,334.47
| Professional | | $341.55 | $611.04 | $4,334.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $9,401.00
| Facility | | $2,155.00 | $4,983.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.00 / $572.85 / $1,294.21
| Professional | | $297.00 | $572.85 | $1,294.21 |