- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.05 / $2,414.00 / $4,355.00
| Facility | | $497.05 | $2,414.00 | $4,355.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.37 / $421.71 / $797.61
| Professional | | $265.37 | $421.71 | $797.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.37 / $2,386.67 / $8,498.00
| Facility | | $825.37 | $2,386.67 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.38 / $721.48 / $2,868.00
| Professional | | $358.38 | $721.48 | $2,868.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.19 / $541.04 / $954.74
| Facility | | $416.19 | $541.04 | $954.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.77 / $767.06 / $1,128.26
| Professional | | $564.77 | $767.06 | $1,128.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.72 / $663.28 / $1,340.25
| Professional | | $392.72 | $663.28 | $1,340.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.72 / $758.88 / $6,679.00
| Facility | | $348.72 | $758.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.44 / $656.85 / $907.00
| Professional | | $518.44 | $656.85 | $907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.85 / $899.73 / $1,393.76
| Professional | | $428.85 | $899.73 | $1,393.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,232.85 / $4,232.85 / $4,232.85
| Facility | | $4,232.85 | $4,232.85 | $4,232.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $26,542.00
| Facility | | $1,640.00 | $3,372.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.32 / $864.24 / $3,354.48
| Professional | | $493.32 | $864.24 | $3,354.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.03 / $641.64 / $1,271.85
| Professional | | $413.03 | $641.64 | $1,271.85 |