- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.96 / $2,079.00 / $3,625.00
| Facility | | $441.96 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.69 / $441.96 / $868.09
| Professional | | $361.69 | $441.96 | $868.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,764.00 / $12,000.00
| Facility | | $818.35 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.50 / $879.95 / $6,333.47
| Professional | | $340.50 | $879.95 | $6,333.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.92 / $516.50 / $912.83
| Facility | | $397.92 | $516.50 | $912.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.46 / $809.71 / $1,588.65
| Professional | | $502.46 | $809.71 | $1,588.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.02 / $725.56 / $6,679.00
| Facility | | $342.02 | $725.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.82 / $506.12 / $788.91
| Professional | | $262.82 | $506.12 | $788.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.73 / $913.75 / $1,317.00
| Professional | | $438.73 | $913.75 | $1,317.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,249.00 / $12,000.00
| Facility | | $1,902.00 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.79 / $1,235.34 / $6,333.47
| Professional | | $565.79 | $1,235.34 | $6,333.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.28 / $791.52 / $1,595.12
| Professional | | $490.28 | $791.52 | $1,595.12 |