- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.00 / $2,747.00 / $5,048.00
| Facility | | $509.00 | $2,747.00 | $5,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.98 / $508.25 / $949.75
| Professional | | $336.98 | $508.25 | $949.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.41 / $2,854.00 / $9,039.00
| Facility | | $863.41 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.85 / $860.59 / $3,802.00
| Professional | | $405.85 | $860.59 | $3,802.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.87 / $560.09 / $999.89
| Facility | | $435.87 | $560.09 | $999.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.27 / $857.15 / $1,311.75
| Professional | | $596.27 | $857.15 | $1,311.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.34 / $763.05 / $1,464.50
| Professional | | $461.34 | $763.05 | $1,464.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.09 / $794.76 / $6,679.00
| Facility | | $369.09 | $794.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.09 / $734.23 / $1,013.53
| Professional | | $605.09 | $734.23 | $1,013.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.67 / $1,001.93 / $1,509.34
| Professional | | $478.67 | $1,001.93 | $1,509.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,231.20 / $4,231.20 / $4,456.24
| Facility | | $4,231.20 | $4,231.20 | $4,456.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,867.08 / $3,764.00 / $26,542.00
| Facility | | $1,867.08 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.59 / $1,103.60 / $3,802.00
| Professional | | $571.59 | $1,103.60 | $3,802.00 |
- 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
- $509.86 / $799.12 / $1,578.13
| Professional | | $509.86 | $799.12 | $1,578.13 |