- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,693.00
| Facility | | $1,485.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.91 / $404.99 / $894.87
| Professional | | $328.91 | $404.99 | $894.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.41 / $1,866.13 / $4,952.00
| Facility | | $379.41 | $1,866.13 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.27 / $655.93 / $2,806.88
| Professional | | $369.27 | $655.93 | $2,806.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.55 / $645.11 / $1,052.36
| Professional | | $468.55 | $645.11 | $1,052.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.11 / $689.83 / $1,272.01
| Professional | | $393.11 | $689.83 | $1,272.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $538.01 / $8,090.00
| Facility | | $300.00 | $538.01 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.83 / $383.23 / $617.84
| Professional | | $205.83 | $383.23 | $617.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.56 / $825.79 / $1,048.48
| Professional | | $416.56 | $825.79 | $1,048.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.09 / $534.09 / $534.09
| Professional | | $534.09 | $534.09 | $534.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,133.00 / $8,498.00
| Facility | | $55.00 | $3,133.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.57 / $659.72 / $2,806.88
| Professional | | $383.57 | $659.72 | $2,806.88 |
- 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
- $365.65 / $492.34 / $1,117.06
| Professional | | $365.65 | $492.34 | $1,117.06 |