- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.46 / $2,070.00 / $7,629.00
| Facility | | $407.46 | $2,070.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.99 / $226.05 / $469.20
| Professional | | $127.99 | $226.05 | $469.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.63 / $378.39 / $378.39
| Professional | | $364.63 | $378.39 | $378.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.83 / $306.63 / $589.82
| Professional | | $142.83 | $306.63 | $589.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.46 / $591.74 / $604.82
| Professional | | $445.46 | $591.74 | $604.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.77 / $474.77 / $474.77
| Facility | | $474.77 | $474.77 | $474.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,266.00 / $8,017.00
| Facility | | $594.00 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.43 / $323.36 / $871.96
| Professional | | $130.43 | $323.36 | $871.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $299.50 / $1,008.80
| Professional | | $5.00 | $299.50 | $1,008.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.86 / $323.83 / $589.82
| Professional | | $142.86 | $323.83 | $589.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.72 / $155.30 / $361.85
| Facility | | $130.72 | $155.30 | $361.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.72 / $264.25 / $391.18
| Professional | | $130.72 | $264.25 | $391.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.98 / $355.75 / $685.33
| Professional | | $228.98 | $355.75 | $685.33 |