- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $2,933.89 / $3,973.92
| Facility | | $500.00 | $2,933.89 | $3,973.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $845.65
| Professional | | $500.00 | $500.00 | $845.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.53 / $1,706.15 / $6,193.76
| Facility | | $533.53 | $1,706.15 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $632.64 / $2,284.90
| Professional | | $350.94 | $632.64 | $2,284.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.98 / $1,545.15 / $2,869.90
| Facility | | $56.98 | $1,545.15 | $2,869.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.71 / $1,225.71 / $1,264.83
| Professional | | $1,225.71 | $1,225.71 | $1,264.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $654.82 / $1,330.67
| Facility | | $408.71 | $654.82 | $1,330.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $584.55 / $2,899.61
| Professional | | $350.94 | $584.55 | $2,899.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.45 / $1,881.45 / $2,213.46
| Professional | | $1,881.45 | $1,881.45 | $2,213.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $2,196.63
| Professional | | $1,303.95 | $1,303.95 | $2,196.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.00 / $1,560.00 / $1,560.00
| Facility | | $1,560.00 | $1,560.00 | $1,560.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.87 / $6,193.76 / $6,193.76
| Facility | | $2,268.87 | $6,193.76 | $6,193.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $646.70 / $6,493.67
| Professional | | $350.94 | $646.70 | $6,493.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $782.37 / $1,807.27
| Professional | | $350.94 | $782.37 | $1,807.27 |