- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.43 / $890.60 / $7,926.78
| Facility | | $0.43 | $890.60 | $7,926.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.36 / $890.60 / $1,465.00
| Professional | | $770.36 | $890.60 | $1,465.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.09 / $971.41 / $971.41
| Professional | | $936.09 | $971.41 | $971.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.25 / $1,293.58 / $2,013.18
| Professional | | $927.25 | $1,293.58 | $2,013.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.00 / $1,538.54 / $1,850.00
| Professional | | $900.00 | $1,538.54 | $1,850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.43 / $890.60 / $7,926.78
| Facility | | $0.43 | $890.60 | $7,926.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.49 / $1,208.19 / $2,645.08
| Professional | | $807.49 | $1,208.19 | $2,645.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,290.20 / $2,305.90
| Professional | | $7.00 | $1,290.20 | $2,305.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.63 / $1,279.85 / $2,184.04
| Professional | | $936.63 | $1,279.85 | $2,184.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.76 / $920.76 / $1,703.00
| Facility | | $920.76 | $920.76 | $1,703.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.16 / $942.62 / $1,703.00
| Professional | | $875.16 | $942.62 | $1,703.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.13 / $1,216.68 / $1,920.24
| Professional | | $966.13 | $1,216.68 | $1,920.24 |