- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,399.00 / $6,682.43
| Facility | | $988.00 | $2,399.00 | $6,682.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.05 / $422.20 / $1,026.84
| Professional | | $406.05 | $422.20 | $1,026.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,078.00 / $2,796.00
| Facility | | $627.00 | $1,078.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.73 / $693.52 / $2,416.59
| Professional | | $356.73 | $693.52 | $2,416.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,700.00 / $14,868.13 / $20,251.00
| Facility | | $3,700.00 | $14,868.13 | $20,251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.76 / $835.01 / $1,294.85
| Professional | | $698.76 | $835.01 | $1,294.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.24 / $784.24 / $6,679.00
| Facility | | $379.24 | $784.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.31 / $449.96 / $687.83
| Professional | | $233.31 | $449.96 | $687.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.85 / $878.03 / $1,164.99
| Professional | | $462.85 | $878.03 | $1,164.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,844.38 / $3,445.00
| Facility | | $627.00 | $1,844.38 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.01 / $784.24 / $2,416.59
| Professional | | $491.01 | $784.24 | $2,416.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.32 / $693.52 / $1,412.28
| Professional | | $489.32 | $693.52 | $1,412.28 |