- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,015.00 / $2,733.00 / $4,712.00
| Facility | | $1,015.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.98 / $639.29 / $1,519.95
| Professional | | $523.98 | $639.29 | $1,519.95 |
- 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
- $598.25 / $1,075.65 / $4,544.78
| Professional | | $598.25 | $1,075.65 | $4,544.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.17 / $1,107.84 / $1,500.76
| Professional | | $747.17 | $1,107.84 | $1,500.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.28 / $998.62 / $1,651.37
| Professional | | $602.28 | $998.62 | $1,651.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.54 / $1,231.82 / $6,679.00
| Facility | | $574.54 | $1,231.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.30 / $798.62 / $1,084.00
| Professional | | $659.30 | $798.62 | $1,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.07 / $1,409.63 / $1,859.52
| Professional | | $711.07 | $1,409.63 | $1,859.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,891.78 / $6,891.78 / $6,891.78
| Facility | | $6,891.78 | $6,891.78 | $6,891.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.11 / $648.11 / $1,190.74
| Professional | | $492.11 | $648.11 | $1,190.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $26,542.00
| Facility | | $1,902.00 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.37 / $1,115.83 / $4,544.78
| Professional | | $656.37 | $1,115.83 | $4,544.78 |
- 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
- $625.55 / $920.37 / $1,665.92
| Professional | | $625.55 | $920.37 | $1,665.92 |