- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.00 / $4,043.00 / $9,661.00
| Facility | | $1,508.00 | $4,043.00 | $9,661.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.08 / $988.59 / $1,000.00
| Professional | | $260.08 | $988.59 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.30 / $696.07 / $1,375.97
| Professional | | $572.30 | $696.07 | $1,375.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,511.50 / $5,511.50 / $16,534.50
| Facility | | $5,511.50 | $5,511.50 | $16,534.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.29 / $434.29 / $14,648.00
| Facility | | $434.29 | $434.29 | $14,648.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.62 / $1,808.56 / $1,808.56
| Professional | | $352.62 | $1,808.56 | $1,808.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $420.73 / $850.21
| Facility | | $319.00 | $420.73 | $850.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.36 / $411.07 / $729.29
| Professional | | $210.36 | $411.07 | $729.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.52 / $300.52 / $300.52
| Facility | | $300.52 | $300.52 | $300.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.77 / $420.73 / $662.66
| Professional | | $278.77 | $420.73 | $662.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.29 / $555.00 / $597.00
| Facility | | $434.29 | $555.00 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.62 / $1,808.56 / $1,808.56
| Professional | | $352.62 | $1,808.56 | $1,808.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.00 / $2,826.00 / $4,851.00
| Facility | | $964.00 | $2,826.00 | $4,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.82 / $423.91 / $1,015.29
| Professional | | $300.82 | $423.91 | $1,015.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.52 / $300.52 / $300.82
| Facility | | $300.52 | $300.52 | $300.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.52 / $300.52 / $662.66
| Professional | | $300.52 | $300.52 | $662.66 |