- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,818.38 / $5,623.41
| Facility | | $489.78 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $1,174.90
| Professional | | $407.38 | $537.03 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $2,818.38
| Facility | | $56.23 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,479.11
| Professional | | $398.11 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,148.15
| Facility | | $501.19 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $1,148.15
| Professional | | $501.19 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $1,230.27
| Professional | | $426.58 | $724.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $660.69 / $8,511.38
| Facility | | $302.00 | $660.69 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $630.96 / $912.01
| Professional | | $512.86 | $630.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $758.58 / $1,174.90
| Professional | | $467.74 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $2,818.38
| Facility | | $56.23 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $660.69 / $1,479.11
| Professional | | $398.11 | $660.69 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $691.83 / $1,230.27
| Professional | | $467.74 | $691.83 | $1,230.27 |