- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $1,828.50 / $2,422.84
| Facility | | $825.00 | $1,828.50 | $2,422.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.95 / $825.00 / $825.00
| Professional | | $643.95 | $825.00 | $825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.15 / $2,434.29 / $3,776.25
| Facility | | $929.15 | $2,434.29 | $3,776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $795.00 / $2,985.25
| Professional | | $477.00 | $795.00 | $2,985.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.00 / $1,743.86 / $3,159.18
| Facility | | $1,113.00 | $1,743.86 | $3,159.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.00 / $645.00 / $645.00
| Professional | | $645.00 | $645.00 | $645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.91 / $555.53 / $1,808.63
| Facility | | $521.91 | $555.53 | $1,808.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $715.19 / $3,547.71
| Professional | | $477.00 | $715.19 | $3,547.71 |
- 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
- $1,147.27 / $1,147.27 / $1,349.73
| Professional | | $1,147.27 | $1,147.27 | $1,349.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.00 / $795.00 / $2,432.69
| Professional | | $795.00 | $795.00 | $2,432.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.30 / $3,776.25 / $3,776.25
| Facility | | $1,383.30 | $3,776.25 | $3,776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.60 / $477.00 / $3,975.00
| Professional | | $381.60 | $477.00 | $3,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.90 / $477.00 / $1,515.33
| Professional | | $333.90 | $477.00 | $1,515.33 |