- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.05 / $2,581.76 / $3,625.00
| Facility | | $627.05 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.05 / $361.00 / $1,117.24
| Professional | | $115.05 | $361.00 | $1,117.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.07 / $1,213.92 / $3,472.00
| Facility | | $310.07 | $1,213.92 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.87 / $869.83 / $2,307.77
| Professional | | $140.87 | $869.83 | $2,307.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.21 / $196.57 / $385.59
| Facility | | $151.21 | $196.57 | $385.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.53 / $654.48 / $1,034.08
| Professional | | $128.53 | $654.48 | $1,034.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.50 / $663.35 / $1,806.15
| Professional | | $177.50 | $663.35 | $1,806.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.15 / $214.32 / $6,679.00
| Facility | | $133.15 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.78 / $882.80 / $1,235.50
| Professional | | $696.78 | $882.80 | $1,235.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.43 / $646.19 / $1,683.89
| Professional | | $163.43 | $646.19 | $1,683.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.72 / $2,677.50 / $3,863.50
| Facility | | $558.72 | $2,677.50 | $3,863.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,600.00 / $7,161.00
| Facility | | $55.00 | $1,600.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.69 / $1,219.05 / $4,450.88
| Professional | | $752.69 | $1,219.05 | $4,450.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.28 / $1,052.99 / $1,774.42
| Professional | | $664.28 | $1,052.99 | $1,774.42 |