- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.50 / $2,083.00 / $3,685.00
| Facility | | $923.50 | $2,083.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.18 / $324.95 / $876.20
| Professional | | $250.18 | $324.95 | $876.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.72 / $947.00 / $2,733.00
| Facility | | $409.72 | $947.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.89 / $422.54 / $1,077.95
| Professional | | $252.89 | $422.54 | $1,077.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.59 / $564.32 / $749.96
| Professional | | $337.59 | $564.32 | $749.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.85 / $346.87 / $475.90
| Facility | | $199.85 | $346.87 | $475.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.83 / $445.39 / $909.32
| Professional | | $284.83 | $445.39 | $909.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.30 / $615.55 / $6,679.00
| Facility | | $277.30 | $615.55 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.52 / $303.45 / $460.44
| Professional | | $165.52 | $303.45 | $460.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.37 / $590.40 / $825.31
| Professional | | $331.37 | $590.40 | $825.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.02 / $377.05 / $415.94
| Professional | | $371.02 | $377.05 | $415.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.74 / $1,457.44 / $3,445.00
| Facility | | $544.74 | $1,457.44 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.64 / $422.54 / $1,841.31
| Professional | | $290.64 | $422.54 | $1,841.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.92 / $402.36 / $848.09
| Professional | | $271.92 | $402.36 | $848.09 |