- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.88 / $1,181.00 / $7,439.00
| Facility | | $322.88 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.88 / $337.44 / $656.98
| Professional | | $322.88 | $337.44 | $656.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.61 / $1,457.61 / $1,478.88
| Facility | | $1,457.61 | $1,457.61 | $1,478.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.68 / $584.26 / $1,057.05
| Professional | | $355.68 | $584.26 | $1,057.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,587.44
| Facility | | $530.04 | $530.04 | $1,587.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.98 / $502.33 / $923.67
| Professional | | $392.98 | $502.33 | $923.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.88 / $492.54 / $759.78
| Facility | | $322.88 | $492.54 | $759.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.00 / $485.00 / $600.00
| Professional | | $437.00 | $485.00 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $439.40 / $1,261.50
| Professional | | $5.00 | $439.40 | $1,261.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.06 / $480.01 / $911.70
| Professional | | $312.06 | $480.01 | $911.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.08 / $5,246.20 / $16,394.00
| Facility | | $1,870.08 | $5,246.20 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,232.86 / $3,232.86 / $3,232.86
| Professional | | $3,232.86 | $3,232.86 | $3,232.86 |