- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.81 / $2,079.00 / $3,625.00
| Facility | | $451.81 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.96 / $382.88 / $631.77
| Professional | | $230.96 | $382.88 | $631.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $12,000.00
| Facility | | $1,106.00 | $2,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.85 / $1,025.45 / $3,679.82
| Professional | | $510.85 | $1,025.45 | $3,679.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.79 / $363.39 / $671.05
| Facility | | $282.79 | $363.39 | $671.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.74 / $588.26 / $1,085.43
| Professional | | $309.74 | $588.26 | $1,085.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $363.50 / $6,679.00
| Facility | | $214.32 | $363.50 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.76 / $604.66 / $834.68
| Professional | | $497.76 | $604.66 | $834.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.11 / $666.85 / $1,273.64
| Professional | | $316.11 | $666.85 | $1,273.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $12,000.00
| Facility | | $1,106.00 | $2,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.24 / $973.55 / $3,679.82
| Professional | | $507.24 | $973.55 | $3,679.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.88 / $716.47 / $1,318.43
| Professional | | $479.88 | $716.47 | $1,318.43 |