- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $1,919.00 / $4,834.72
| Facility | | $699.00 | $1,919.00 | $4,834.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.37 / $784.92 / $1,884.36
| Professional | | $569.37 | $784.92 | $1,884.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $3,315.28 / $8,498.00
| Facility | | $1,089.00 | $3,315.28 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.59 / $1,328.97 / $5,155.28
| Professional | | $662.59 | $1,328.97 | $5,155.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.64 / $1,099.33 / $1,939.90
| Facility | | $845.64 | $1,099.33 | $1,939.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.08 / $1,301.94 / $2,699.35
| Professional | | $821.08 | $1,301.94 | $2,699.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.50 / $1,541.94 / $6,679.00
| Facility | | $713.50 | $1,541.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.31 / $1,204.15 / $1,662.20
| Professional | | $958.31 | $1,204.15 | $1,662.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.01 / $1,826.90 / $2,668.70
| Professional | | $888.01 | $1,826.90 | $2,668.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.94 / $2,788.20 / $3,863.50
| Facility | | $594.94 | $2,788.20 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.33 / $1,123.33 / $2,052.69
| Professional | | $1,123.33 | $1,123.33 | $2,052.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,597.37 / $16,394.00
| Facility | | $1,640.00 | $3,597.37 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.22 / $1,613.52 / $6,224.16
| Professional | | $950.22 | $1,613.52 | $6,224.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $8,425.00
| Facility | | $1,640.00 | $3,592.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.70 / $1,234.08 / $2,329.46
| Professional | | $784.70 | $1,234.08 | $2,329.46 |