- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.00 / $5,370.00 / $10,686.00
| Facility | | $1,819.00 | $5,370.00 | $10,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.78 / $245.20 / $294.52
| Professional | | $164.78 | $245.20 | $294.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $4,133.00 / $9,074.00
| Facility | | $2,385.00 | $4,133.00 | $9,074.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.79 / $234.44 / $422.90
| Professional | | $190.79 | $234.44 | $422.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.16 / $275.16 / $275.16
| Facility | | $275.16 | $275.16 | $275.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.96 / $1,145.96 / $1,145.96
| Professional | | $1,145.96 | $1,145.96 | $1,145.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.06 / $327.78 / $512.84
| Professional | | $226.06 | $327.78 | $512.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.16 / $555.00 / $74,999.25
| Facility | | $275.16 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,145.96 / $1,145.96 / $1,145.96
| Professional | | $1,145.96 | $1,145.96 | $1,145.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,731.00 / $12,509.00
| Facility | | $2,264.00 | $5,731.00 | $12,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.79 / $277.06 / $567.51
| Professional | | $210.79 | $277.06 | $567.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.58 / $232.58 / $232.58
| Facility | | $232.58 | $232.58 | $232.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.58 / $232.58 / $512.84
| Professional | | $232.58 | $232.58 | $512.84 |