- 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
- $396.36 / $596.97 / $1,433.83
| Professional | | $396.36 | $596.97 | $1,433.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $3,295.38 / $8,498.00
| Facility | | $941.10 | $3,295.38 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.04 / $1,285.57 / $14,693.94
| Professional | | $544.04 | $1,285.57 | $14,693.94 |
- 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
- $603.39 / $909.30 / $2,107.98
| Professional | | $603.39 | $909.30 | $2,107.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.53 / $1,206.64 / $6,679.00
| Facility | | $561.53 | $1,206.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.36 / $780.53 / $1,061.83
| Professional | | $644.36 | $780.53 | $1,061.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.72 / $1,430.74 / $2,274.73
| Professional | | $721.72 | $1,430.74 | $2,274.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $12,000.00
| Facility | | $1,640.00 | $3,592.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.60 / $1,632.63 / $14,693.94
| Professional | | $640.60 | $1,632.63 | $14,693.94 |
- 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
- $640.60 / $1,333.40 / $3,347.83
| Professional | | $640.60 | $1,333.40 | $3,347.83 |