- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,890.45 / $12,022.64
| Facility | | $1,000.00 | $3,890.45 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,096.48 / $1,621.81
| Professional | | $933.25 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,096.48 / $1,479.11
| Professional | | $870.96 | $1,096.48 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $2,137.96
| Professional | | $1,000.00 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $22,387.21
| Facility | | $54.95 | $56.23 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,128.31 / $8,128.31
| Professional | | $6,760.83 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,905.46 / $7,943.28
| Facility | | $933.25 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,258.93 / $1,621.81
| Professional | | $933.25 | $1,258.93 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $758.58
| Professional | | $32.36 | $33.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $2,290.87
| Facility | | $912.01 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,137.96
| Professional | | $933.25 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,454.71 / $10,232.93
| Facility | | $436.52 | $2,454.71 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,698.24
| Professional | | $812.83 | $1,122.02 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |