- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $2,581.76 / $3,693.00
| Facility | | $699.00 | $2,581.76 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.86 / $542.97 / $1,064.73
| Professional | | $311.86 | $542.97 | $1,064.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.68 / $2,025.78 / $7,835.00
| Facility | | $913.68 | $2,025.78 | $7,835.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.46 / $983.78 / $2,965.68
| Professional | | $455.46 | $983.78 | $2,965.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.72 / $621.04 / $1,095.89
| Facility | | $477.72 | $621.04 | $1,095.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.64 / $830.10 / $1,725.00
| Professional | | $466.64 | $830.10 | $1,725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $611.46 / $6,679.00
| Facility | | $214.32 | $611.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.35 / $895.94 / $1,236.75
| Professional | | $711.35 | $895.94 | $1,236.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.77 / $1,071.75 / $1,768.49
| Professional | | $510.77 | $1,071.75 | $1,768.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.98 / $2,479.02 / $4,320.31
| Facility | | $1,859.98 | $2,479.02 | $4,320.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.10 / $638.10 / $638.10
| Professional | | $638.10 | $638.10 | $638.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $16,394.00
| Facility | | $1,106.00 | $2,078.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.93 / $1,328.71 / $4,612.00
| Professional | | $741.93 | $1,328.71 | $4,612.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,510.00 / $8,281.00
| Facility | | $1,106.00 | $2,510.00 | $8,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.63 / $967.37 / $1,678.10
| Professional | | $558.63 | $967.37 | $1,678.10 |