- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.09 / $2,747.00 / $5,454.00
| Facility | | $389.09 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.09 / $645.65 / $1,439.31
| Professional | | $389.09 | $645.65 | $1,439.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $6,984.89
| Facility | | $55.00 | $2,854.00 | $6,984.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.21 / $1,042.07 / $3,996.00
| Professional | | $719.21 | $1,042.07 | $3,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,932.00 / $19,879.00 / $21,263.00
| Facility | | $18,932.00 | $19,879.00 | $21,263.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.66 / $1,150.85 / $1,514.35
| Professional | | $786.66 | $1,150.85 | $1,514.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $869.87 / $8,090.00
| Facility | | $300.00 | $869.87 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.79 / $793.09 / $1,417.99
| Professional | | $640.79 | $793.09 | $1,417.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.32 / $1,320.92 / $1,734.25
| Professional | | $696.32 | $1,320.92 | $1,734.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $6,984.89
| Facility | | $55.00 | $2,854.00 | $6,984.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.21 / $1,042.07 / $3,996.00
| Professional | | $719.21 | $1,042.07 | $3,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.21 / $906.07 / $1,930.60
| Professional | | $719.21 | $906.07 | $1,930.60 |