- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.44 / $2,663.12 / $3,625.00
| Facility | | $426.44 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.25 / $454.98 / $742.20
| Professional | | $389.25 | $454.98 | $742.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.09 / $1,856.00 / $4,142.00
| Facility | | $732.09 | $1,856.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.84 / $878.64 / $3,454.64
| Professional | | $425.84 | $878.64 | $3,454.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.36 / $676.37 / $1,207.47
| Facility | | $526.36 | $676.37 | $1,207.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.51 / $760.25 / $1,323.78
| Professional | | $467.51 | $760.25 | $1,323.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.06 / $959.76 / $6,679.00
| Facility | | $440.06 | $959.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.99 / $674.54 / $931.13
| Professional | | $554.99 | $674.54 | $931.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.54 / $1,100.00 / $1,474.68
| Professional | | $543.54 | $1,100.00 | $1,474.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.53 / $3,025.53 / $3,025.53
| Facility | | $3,025.53 | $3,025.53 | $3,025.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $16,394.00
| Facility | | $627.00 | $2,217.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.69 / $945.25 / $3,454.64
| Professional | | $495.69 | $945.25 | $3,454.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,153.77 / $4,932.68
| Facility | | $627.00 | $2,153.77 | $4,932.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.02 / $718.42 / $1,499.02
| Professional | | $476.02 | $718.42 | $1,499.02 |