- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.00 / $3,748.00 / $8,017.00
| Facility | | $749.00 | $3,748.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.45 / $593.17 / $913.56
| Professional | | $515.45 | $593.17 | $913.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $5,951.00 / $8,887.00
| Facility | | $2,800.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.36 / $825.82 / $1,161.42
| Professional | | $519.36 | $825.82 | $1,161.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.91 / $762.18 / $1,211.24
| Professional | | $567.91 | $762.18 | $1,211.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.38 / $909.62 / $913.94
| Professional | | $687.38 | $909.62 | $913.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,285.12 / $7,285.12 / $7,285.12
| Facility | | $7,285.12 | $7,285.12 | $7,285.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,964.00 / $8,017.00
| Facility | | $832.00 | $3,964.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.53 / $654.26 / $1,749.00
| Professional | | $538.53 | $654.26 | $1,749.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $732.90 / $1,465.30
| Professional | | $3.00 | $732.90 | $1,465.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.67 / $767.54 / $1,260.03
| Professional | | $578.67 | $767.54 | $1,260.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.35 / $571.35 / $650.44
| Facility | | $571.35 | $571.35 | $650.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.55 / $573.58 / $650.44
| Professional | | $554.55 | $573.58 | $650.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.75 / $728.18 / $1,183.60
| Professional | | $557.75 | $728.18 | $1,183.60 |