- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.43 / $440.52 / $714.93
| Professional | | $404.43 | $440.52 | $714.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.64 / $1,578.89 / $3,250.27
| Facility | | $515.64 | $1,578.89 | $3,250.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.35 / $773.46 / $3,328.72
| Professional | | $425.35 | $773.46 | $3,328.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.42 / $911.03 / $1,234.13
| Professional | | $614.42 | $911.03 | $1,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.68 / $727.82 / $1,294.25
| Professional | | $463.68 | $727.82 | $1,294.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $709.09 / $6,679.00
| Facility | | $214.32 | $709.09 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.12 / $645.78 / $891.42
| Professional | | $533.12 | $645.78 | $891.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.85 / $1,123.59 / $1,484.70
| Professional | | $573.85 | $1,123.59 | $1,484.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.03 / $575.03 / $575.03
| Professional | | $575.03 | $575.03 | $575.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,717.28 / $4,142.00
| Facility | | $55.00 | $1,717.28 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.93 / $835.40 / $3,328.72
| Professional | | $438.93 | $835.40 | $3,328.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.99 / $646.89 / $1,396.91
| Professional | | $425.99 | $646.89 | $1,396.91 |