- 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
- $181.70 / $269.47 / $324.27
| Professional | | $181.70 | $269.47 | $324.27 |
- 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 / $224.46 / $360.65
| Professional | | $190.79 | $224.46 | $360.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.37 / $292.37 / $292.37
| Facility | | $292.37 | $292.37 | $292.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.68 / $1,217.68 / $1,217.68
| Professional | | $1,217.68 | $1,217.68 | $1,217.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.66 / $390.66 / $390.66
| Professional | | $390.66 | $390.66 | $390.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.17 / $348.25 / $544.87
| Professional | | $240.17 | $348.25 | $544.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.37 / $555.00 / $74,999.25
| Facility | | $292.37 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,217.68 / $1,217.68 / $1,217.68
| Professional | | $1,217.68 | $1,217.68 | $1,217.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.00 / $4,194.00 / $9,202.00
| Facility | | $1,683.00 | $4,194.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.65 / $318.70 / $674.32
| Professional | | $237.65 | $318.70 | $674.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.96 / $351.15 / $351.15
| Facility | | $333.96 | $351.15 | $351.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.04 / $351.15 / $652.92
| Professional | | $210.04 | $351.15 | $652.92 |