- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.66 / $2,663.12 / $3,625.00
| Facility | | $532.66 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $532.66 / $922.12
| Professional | | $338.84 | $532.66 | $922.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.73 / $2,376.00 / $8,498.00
| Facility | | $834.73 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.81 / $978.64 / $4,427.68
| Professional | | $438.81 | $978.64 | $4,427.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.34 / $630.09 / $1,124.83
| Facility | | $490.34 | $630.09 | $1,124.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.41 / $844.36 / $1,488.44
| Professional | | $462.41 | $844.36 | $1,488.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.56 / $894.08 / $6,679.00
| Facility | | $410.56 | $894.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.07 / $873.64 / $1,210.65
| Professional | | $716.07 | $873.64 | $1,210.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.29 / $1,120.94 / $1,782.37
| Professional | | $533.29 | $1,120.94 | $1,782.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.60 / $928.60 / $928.60
| Professional | | $928.60 | $928.60 | $928.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $16,394.00
| Facility | | $1,640.00 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.57 / $1,179.35 / $4,427.68
| Professional | | $632.57 | $1,179.35 | $4,427.68 |
- 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
- $605.66 / $869.58 / $1,840.09
| Professional | | $605.66 | $869.58 | $1,840.09 |