- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.61 / $335.13 / $549.91
| Professional | | $308.61 | $335.13 | $549.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,133.00 / $8,957.00
| Facility | | $822.00 | $3,133.00 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.97 / $589.11 / $3,833.47
| Professional | | $336.97 | $589.11 | $3,833.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.37 / $694.46 / $1,051.08
| Professional | | $468.37 | $694.46 | $1,051.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.75 / $554.80 / $985.77
| Professional | | $363.75 | $554.80 | $985.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.88 / $772.18 / $6,679.00
| Facility | | $353.88 | $772.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.08 / $492.26 / $679.52
| Professional | | $406.08 | $492.26 | $679.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.04 / $866.39 / $1,142.90
| Professional | | $437.04 | $866.39 | $1,142.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,465.42 / $1,465.42 / $1,465.42
| Facility | | $1,465.42 | $1,465.42 | $1,465.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.96 / $3,592.00 / $12,000.00
| Facility | | $1,307.96 | $3,592.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.89 / $639.73 / $3,833.47
| Professional | | $365.89 | $639.73 | $3,833.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.96 / $530.54 / $1,088.49
| Professional | | $352.96 | $530.54 | $1,088.49 |