- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.39 / $2,663.12 / $3,625.00
| Facility | | $319.39 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.75 / $353.89 / $725.40
| Professional | | $206.75 | $353.89 | $725.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,052.09 / $3,445.00
| Facility | | $627.00 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.79 / $631.66 / $2,025.68
| Professional | | $306.79 | $631.66 | $2,025.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.18 / $429.23 / $757.43
| Facility | | $330.18 | $429.23 | $757.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.39 / $621.52 / $1,305.88
| Professional | | $354.39 | $621.52 | $1,305.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.29 / $602.04 / $6,679.00
| Facility | | $285.29 | $602.04 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.86 / $607.44 / $838.50
| Professional | | $480.86 | $607.44 | $838.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.80 / $733.99 / $1,185.80
| Professional | | $349.80 | $733.99 | $1,185.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,928.94 / $16,394.00
| Facility | | $627.00 | $1,928.94 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.32 / $797.86 / $3,106.48
| Professional | | $447.32 | $797.86 | $3,106.48 |
- 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
- $382.53 / $600.30 / $1,240.89
| Professional | | $382.53 | $600.30 | $1,240.89 |