- 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
- $500.82 / $653.04 / $998.45
| Professional | | $500.82 | $653.04 | $998.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,814.37 / $9,039.00
| Facility | | $1,313.00 | $3,814.37 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.25 / $841.28 / $4,346.72
| Professional | | $527.25 | $841.28 | $4,346.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.86 / $1,193.91 / $1,586.28
| Professional | | $901.86 | $1,193.91 | $1,586.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.12 / $1,078.10 / $1,892.21
| Professional | | $559.12 | $1,078.10 | $1,892.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.66 / $1,302.02 / $6,679.00
| Facility | | $598.66 | $1,302.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.53 / $830.04 / $1,145.78
| Professional | | $661.53 | $830.04 | $1,145.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.36 / $1,474.97 / $4,172.22
| Professional | | $732.36 | $1,474.97 | $4,172.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.79 / $850.79 / $940.32
| Professional | | $850.79 | $850.79 | $940.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,249.00 / $12,000.00
| Facility | | $1,685.00 | $4,249.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.91 / $851.15 / $4,346.72
| Professional | | $589.91 | $851.15 | $4,346.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.98 / $826.89 / $1,767.79
| Professional | | $580.98 | $826.89 | $1,767.79 |