- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $2,663.12 / $4,767.00
| Facility | | $886.00 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.77 / $491.23 / $1,074.54
| Professional | | $434.77 | $491.23 | $1,074.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $9,039.00
| Facility | | $1,061.00 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.86 / $900.08 / $3,573.84
| Professional | | $506.86 | $900.08 | $3,573.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.36 / $979.08 / $1,326.39
| Professional | | $660.36 | $979.08 | $1,326.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.90 / $844.62 / $1,387.55
| Professional | | $499.90 | $844.62 | $1,387.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.78 / $1,088.70 / $6,679.00
| Facility | | $498.78 | $1,088.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.35 / $694.05 / $958.06
| Professional | | $572.35 | $694.05 | $958.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.80 / $1,218.80 / $1,607.79
| Professional | | $614.80 | $1,218.80 | $1,607.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,788.20 / $2,788.20 / $3,025.53
| Facility | | $2,788.20 | $2,788.20 | $3,025.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.82 / $796.82 / $796.82
| Professional | | $796.82 | $796.82 | $796.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.32 / $3,997.00 / $16,394.00
| Facility | | $1,838.32 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.38 / $912.17 / $3,573.84
| Professional | | $535.38 | $912.17 | $3,573.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.59 / $776.12 / $1,464.95
| Professional | | $522.59 | $776.12 | $1,464.95 |