- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.10 / $2,096.25 / $3,693.00
| Facility | | $617.10 | $2,096.25 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.18 / $271.97 / $875.46
| Professional | | $191.18 | $271.97 | $875.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.08 / $3,997.00 / $12,000.00
| Facility | | $504.08 | $3,997.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.02 / $387.35 / $1,466.88
| Professional | | $196.02 | $387.35 | $1,466.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.69 / $393.34 / $641.65
| Professional | | $285.69 | $393.34 | $641.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.69 / $421.47 / $777.16
| Professional | | $239.69 | $421.47 | $777.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.53 / $437.38 / $6,679.00
| Facility | | $206.53 | $437.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.48 / $232.35 / $374.59
| Professional | | $125.48 | $232.35 | $374.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.49 / $501.57 / $734.63
| Professional | | $251.49 | $501.57 | $734.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,673.98 / $4,206.72 / $6,933.27
| Facility | | $1,673.98 | $4,206.72 | $6,933.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.45 / $322.26 / $355.96
| Professional | | $64.45 | $322.26 | $355.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,525.00 / $12,000.00
| Facility | | $1,061.00 | $4,525.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.80 / $415.38 / $1,466.88
| Professional | | $224.80 | $415.38 | $1,466.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.45 / $306.17 / $645.29
| Professional | | $224.45 | $306.17 | $645.29 |