- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $4,767.00
| Facility | | $1,485.00 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.09 / $256.44 / $667.61
| Professional | | $215.09 | $256.44 | $667.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.66 / $3,592.00 / $10,821.00
| Facility | | $498.66 | $3,592.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.05 / $412.36 / $1,955.80
| Professional | | $207.05 | $412.36 | $1,955.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.63 / $391.88 / $740.84
| Professional | | $284.63 | $391.88 | $740.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.33 / $420.42 / $762.09
| Professional | | $271.33 | $420.42 | $762.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.09 / $435.76 / $6,679.00
| Facility | | $209.09 | $435.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.34 / $235.96 / $379.23
| Professional | | $126.34 | $235.96 | $379.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.41 / $511.38 / $771.49
| Professional | | $256.41 | $511.38 | $771.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,899.73 / $3,863.50 / $6,607.16
| Facility | | $2,899.73 | $3,863.50 | $6,607.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $357.39 / $396.89
| Professional | | $306.00 | $357.39 | $396.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,672.00 / $16,394.00
| Facility | | $822.00 | $3,672.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.79 / $435.76 / $1,955.80
| Professional | | $238.79 | $435.76 | $1,955.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.03 / $315.27 / $760.35
| Professional | | $236.03 | $315.27 | $760.35 |