- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.12 / $2,663.12 / $3,625.00
| Facility | | $368.12 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.73 / $394.33 / $823.33
| Professional | | $230.73 | $394.33 | $823.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.46 / $1,267.00 / $7,161.00
| Facility | | $679.46 | $1,267.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.23 / $719.78 / $2,262.40
| Professional | | $348.23 | $719.78 | $2,262.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.93 / $486.11 / $857.80
| Facility | | $373.93 | $486.11 | $857.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.66 / $714.40 / $1,495.36
| Professional | | $398.66 | $714.40 | $1,495.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.29 / $681.82 / $6,679.00
| Facility | | $315.29 | $681.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.80 / $700.39 / $967.30
| Professional | | $552.80 | $700.39 | $967.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.85 / $813.67 / $1,353.03
| Professional | | $394.85 | $813.67 | $1,353.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.21 / $1,028.21 / $1,028.21
| Facility | | $1,028.21 | $1,028.21 | $1,028.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,168.58 / $16,394.00
| Facility | | $1,106.00 | $2,168.58 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.65 / $907.80 / $3,548.40
| Professional | | $500.65 | $907.80 | $3,548.40 |
- 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
- $429.01 / $685.99 / $1,425.62
| Professional | | $429.01 | $685.99 | $1,425.62 |