- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,083.00 / $3,685.00
| Facility | | $988.00 | $2,083.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.37 / $217.85 / $532.91
| Professional | | $163.37 | $217.85 | $532.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.36 / $3,592.00 / $10,821.00
| Facility | | $529.36 | $3,592.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.28 / $399.33 / $1,880.00
| Professional | | $205.28 | $399.33 | $1,880.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.96 / $409.96 / $409.96
| Professional | | $409.96 | $409.96 | $409.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.99 / $453.89 / $822.63
| Professional | | $270.99 | $453.89 | $822.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.28 / $455.82 / $6,679.00
| Facility | | $212.28 | $455.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.82 / $301.77 / $539.54
| Professional | | $238.82 | $301.77 | $539.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.77 / $508.11 / $677.18
| Professional | | $254.77 | $508.11 | $677.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.40 / $3,672.00 / $12,000.00
| Facility | | $1,139.40 | $3,672.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.00 / $448.16 / $1,880.00
| Professional | | $236.00 | $448.16 | $1,880.00 |
- 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
- $226.22 / $323.97 / $707.58
| Professional | | $226.22 | $323.97 | $707.58 |