- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.53 / $2,143.39 / $3,228.00
| Facility | | $759.53 | $2,143.39 | $3,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.72 / $719.07 / $719.07
| Professional | | $455.72 | $719.07 | $719.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.19 / $1,321.58 / $3,607.77
| Facility | | $561.19 | $1,321.58 | $3,607.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.22 / $669.81 / $2,852.06
| Professional | | $95.22 | $669.81 | $2,852.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.53 / $1,726.77 / $3,018.83
| Facility | | $1,207.53 | $1,726.77 | $3,018.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.50 / $609.50 / $751.93
| Professional | | $609.50 | $609.50 | $751.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.22 / $559.52 / $1,480.77
| Facility | | $498.22 | $559.52 | $1,480.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.98 / $747.38 / $3,390.11
| Professional | | $402.98 | $747.38 | $3,390.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.93 / $1,095.93 / $1,289.33
| Professional | | $1,095.93 | $1,095.93 | $1,289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.53 / $759.53 / $2,445.69
| Professional | | $759.53 | $759.53 | $2,445.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,057.92 / $4,057.92 / $4,057.92
| Facility | | $4,057.92 | $4,057.92 | $4,057.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.58 / $3,607.77 / $3,607.77
| Facility | | $1,321.58 | $3,607.77 | $3,607.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.55 / $455.72 / $3,797.65
| Professional | | $75.55 | $455.72 | $3,797.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.55 / $455.72 / $1,134.70
| Professional | | $75.55 | $455.72 | $1,134.70 |