- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.24 / $2,083.00 / $3,625.00
| Facility | | $416.24 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.32 / $418.78 / $606.91
| Professional | | $356.32 | $418.78 | $606.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $941.10 / $2,839.62
| Facility | | $75.00 | $941.10 | $2,839.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.75 / $788.08 / $3,000.08
| Professional | | $410.75 | $788.08 | $3,000.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $149.69 / $448.35
| Professional | | $149.69 | $149.69 | $448.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $230.35 / $276.31
| Facility | | $50.00 | $230.35 | $276.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.66 / $666.91 / $1,295.97
| Professional | | $367.66 | $666.91 | $1,295.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.83 / $891.60 / $6,679.00
| Facility | | $412.83 | $891.60 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.72 / $601.83 / $879.33
| Professional | | $473.72 | $601.83 | $879.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.18 / $967.20 / $1,273.14
| Professional | | $511.18 | $967.20 | $1,273.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,170.84 / $3,170.84 / $3,170.84
| Facility | | $3,170.84 | $3,170.84 | $3,170.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,790.00 / $2,839.62
| Facility | | $55.00 | $1,790.00 | $2,839.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.14 / $801.23 / $3,000.08
| Professional | | $443.14 | $801.23 | $3,000.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.33 / $608.66 / $1,313.37
| Professional | | $423.33 | $608.66 | $1,313.37 |