- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.33 / $530.00 / $1,420.54
| Facility | | $493.33 | $530.00 | $1,420.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.00 / $530.00 / $1,540.80
| Professional | | $325.00 | $530.00 | $1,540.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $1,054.56 / $2,650.40
| Facility | | $800.00 | $1,054.56 | $2,650.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.65 / $840.00 / $2,410.66
| Professional | | $53.65 | $840.00 | $2,410.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.24 / $965.66 / $1,595.60
| Facility | | $638.24 | $965.66 | $1,595.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.47 / $157.47 / $174.98
| Professional | | $157.47 | $157.47 | $174.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.10 / $261.20 / $1,153.16
| Facility | | $55.10 | $261.20 | $1,153.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.55 / $228.18 / $620.49
| Professional | | $182.55 | $228.18 | $620.49 |
- 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
- $1,000.00 / $1,345.07 / $1,886.45
| Professional | | $1,000.00 | $1,345.07 | $1,886.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.25 / $1,354.99 / $1,354.99
| Professional | | $441.25 | $1,354.99 | $1,354.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.40 / $968.40 / $968.40
| Facility | | $968.40 | $968.40 | $968.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $2,410.66 / $2,410.66
| Professional | | $21.46 | $2,410.66 | $2,410.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $53.65 / $1,273.08
| Professional | | $21.46 | $53.65 | $1,273.08 |