- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.00 / $5,382.00 / $16,713.00
| Facility | | $1,798.00 | $5,382.00 | $16,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.02 / $2,400.00 / $2,400.00
| Professional | | $388.02 | $2,400.00 | $2,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.00 / $6,978.00 / $13,707.00
| Facility | | $3,573.00 | $6,978.00 | $13,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.01 / $268.20 / $374.38
| Professional | | $136.01 | $268.20 | $374.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $1,624.45
| Facility | | $66.09 | $100.00 | $1,624.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $120.00 / $393.93
| Professional | | $120.00 | $120.00 | $393.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,970.56 / $2,558.37 / $2,789.25
| Facility | | $1,970.56 | $2,558.37 | $2,789.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,394.40 / $4,000.80 / $4,793.39
| Professional | | $3,394.40 | $4,000.80 | $4,793.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.89 / $345.23 / $668.80
| Facility | | $257.89 | $345.23 | $668.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.92 / $231.50 / $770.82
| Professional | | $214.92 | $231.50 | $770.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.00 / $1,533.00 / $5,830.00
| Facility | | $587.00 | $1,533.00 | $5,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.43 / $436.24 / $912.96
| Professional | | $321.43 | $436.24 | $912.96 |