- 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
- $381.20 / $469.11 / $795.74
| Professional | | $381.20 | $469.11 | $795.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $1,636.36 / $4,711.02
| Facility | | $502.00 | $1,636.36 | $4,711.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.72 / $630.45 / $3,330.00
| Professional | | $408.72 | $630.45 | $3,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.46 / $590.46 / $1,392.16
| Professional | | $590.46 | $590.46 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.16 / $789.93 / $1,341.38
| Professional | | $404.16 | $789.93 | $1,341.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $764.58 / $8,090.00
| Facility | | $300.00 | $764.58 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.67 / $649.54 / $897.11
| Professional | | $512.67 | $649.54 | $897.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.61 / $1,135.10 / $3,830.48
| Professional | | $563.61 | $1,135.10 | $3,830.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,818.00 / $6,887.55
| Facility | | $55.00 | $1,818.00 | $6,887.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.40 / $655.20 / $3,330.00
| Professional | | $430.40 | $655.20 | $3,330.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $1,790.00 / $2,796.00
| Facility | | $502.00 | $1,790.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.29 / $599.08 / $1,340.18
| Professional | | $422.29 | $599.08 | $1,340.18 |