- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.49 / $2,663.12 / $3,625.00
| Facility | | $440.49 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.56 / $500.63 / $980.53
| Professional | | $333.56 | $500.63 | $980.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,496.66 / $8,498.00
| Facility | | $822.00 | $2,496.66 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.91 / $873.91 / $3,960.56
| Professional | | $401.91 | $873.91 | $3,960.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.71 / $553.46 / $988.05
| Facility | | $430.71 | $553.46 | $988.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.01 / $770.54 / $1,119.67
| Professional | | $504.01 | $770.54 | $1,119.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.12 / $760.66 / $1,366.96
| Professional | | $478.12 | $760.66 | $1,366.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.12 / $785.36 / $6,679.00
| Facility | | $363.12 | $785.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.12 / $689.25 / $951.44
| Professional | | $567.12 | $689.25 | $951.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.35 / $987.58 / $1,432.02
| Professional | | $464.35 | $987.58 | $1,432.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.87 / $218.87 / $218.87
| Professional | | $218.87 | $218.87 | $218.87 |
- 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
- $599.85 / $1,081.18 / $3,960.56
| Professional | | $599.85 | $1,081.18 | $3,960.56 |
- 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
- $561.75 / $794.20 / $1,486.36
| Professional | | $561.75 | $794.20 | $1,486.36 |