- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,693.00
| Facility | | $988.00 | $2,094.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.41 / $557.10 / $1,132.54
| Professional | | $457.41 | $557.10 | $1,132.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,997.00 / $12,000.00
| Facility | | $1,061.00 | $3,997.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.71 / $898.46 / $3,352.08
| Professional | | $450.71 | $898.46 | $3,352.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.91 / $918.86 / $1,694.33
| Professional | | $534.91 | $918.86 | $1,694.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.72 / $975.22 / $6,679.00
| Facility | | $455.72 | $975.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.86 / $522.94 / $843.08
| Professional | | $280.86 | $522.94 | $843.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.48 / $1,129.79 / $1,706.68
| Professional | | $566.48 | $1,129.79 | $1,706.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.94 / $1,737.94 / $1,737.94
| Facility | | $1,737.94 | $1,737.94 | $1,737.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,694.48 / $4,525.00 / $12,000.00
| Facility | | $1,694.48 | $4,525.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.83 / $975.22 / $3,352.08
| Professional | | $517.83 | $975.22 | $3,352.08 |
- 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
- $508.38 / $698.12 / $1,668.14
| Professional | | $508.38 | $698.12 | $1,668.14 |