- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.02 / $592.70 / $870.35
| Professional | | $486.02 | $592.70 | $870.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.72 / $3,110.00 / $7,608.00
| Facility | | $854.72 | $3,110.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.88 / $624.67 / $4,119.04
| Professional | | $385.88 | $624.67 | $4,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.35 / $1,110.15 / $1,503.87
| Professional | | $812.35 | $1,110.15 | $1,503.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.16 / $939.31 / $1,584.71
| Professional | | $600.16 | $939.31 | $1,584.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.88 / $1,349.66 / $6,679.00
| Facility | | $385.88 | $1,349.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.80 / $520.94 / $821.92
| Professional | | $442.80 | $520.94 | $821.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.11 / $1,349.28 / $1,794.90
| Professional | | $713.11 | $1,349.28 | $1,794.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.91 / $94.91 / $905.06
| Professional | | $94.91 | $94.91 | $905.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,897.00 / $9,401.00
| Facility | | $2,155.00 | $5,897.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.38 / $562.41 / $4,119.04
| Professional | | $352.38 | $562.41 | $4,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.00 / $5,572.00 / $14,574.00
| Facility | | $1,850.00 | $5,572.00 | $14,574.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.11 / $541.45 / $1,418.65
| Professional | | $343.11 | $541.45 | $1,418.65 |