- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $2,679.00 / $8,017.00
| Facility | | $442.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.76 / $342.05 / $513.82
| Professional | | $231.76 | $342.05 | $513.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.82 / $385.85 / $710.68
| Professional | | $371.82 | $385.85 | $710.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.16 / $429.16 / $429.16
| Facility | | $429.16 | $429.16 | $429.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.62 / $389.03 / $687.44
| Professional | | $256.62 | $389.03 | $687.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.60 / $584.78 / $762.76
| Professional | | $441.60 | $584.78 | $762.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.33 / $383.55 / $384.14
| Professional | | $258.33 | $383.55 | $384.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.00 / $2,679.00 / $8,017.00
| Facility | | $652.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.27 / $372.12 / $817.33
| Professional | | $241.27 | $372.12 | $817.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.20 / $422.20 / $850.40
| Professional | | $422.20 | $422.20 | $850.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.16 / $429.16 / $429.16
| Facility | | $429.16 | $429.16 | $429.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.00 / $396.75 / $696.10
| Professional | | $257.00 | $396.75 | $696.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.17 / $345.64 / $421.85
| Facility | | $244.17 | $345.64 | $421.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.47 / $361.37 / $392.83
| Professional | | $243.47 | $361.37 | $392.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,715.00 / $4,815.00
| Facility | | $1,175.00 | $2,715.00 | $4,815.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.21 / $467.49 / $729.60
| Professional | | $349.21 | $467.49 | $729.60 |