- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,032.00 / $8,920.00
| Facility | | $1,346.00 | $4,032.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.43 / $455.30 / $2,400.00
| Professional | | $328.43 | $455.30 | $2,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,735.00 / $2,390.00 / $2,954.00
| Facility | | $1,735.00 | $2,390.00 | $2,954.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.79 / $299.02 / $421.90
| Professional | | $240.79 | $299.02 | $421.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.96 / $472.96 / $916.00
| Professional | | $472.96 | $472.96 | $916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.03 / $629.03 / $629.03
| Facility | | $629.03 | $629.03 | $629.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,634.90 / $2,634.90 / $2,634.90
| Professional | | $2,634.90 | $2,634.90 | $2,634.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.32 / $647.74 / $771.12
| Professional | | $583.32 | $647.74 | $771.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.14 / $660.19 / $2,616.00
| Facility | | $292.14 | $660.19 | $2,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.48 / $671.00 / $1,080.07
| Professional | | $570.48 | $671.00 | $1,080.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.71 / $543.89 / $1,380.00
| Facility | | $395.71 | $543.89 | $1,380.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.71 / $543.89 / $1,380.00
| Professional | | $395.71 | $543.89 | $1,380.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $1,148.00 / $2,364.00
| Facility | | $296.00 | $1,148.00 | $2,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.90 / $449.67 / $737.87
| Professional | | $347.90 | $449.67 | $737.87 |