- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.62 / $2,663.12 / $4,712.00
| Facility | | $477.62 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.83 / $455.54 / $765.17
| Professional | | $323.83 | $455.54 | $765.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,376.00 / $8,498.00
| Facility | | $822.00 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.01 / $802.75 / $3,502.40
| Professional | | $385.01 | $802.75 | $3,502.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.62 / $535.36 / $955.73
| Facility | | $416.62 | $535.36 | $955.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.86 / $763.83 / $1,202.11
| Professional | | $542.86 | $763.83 | $1,202.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.04 / $715.65 / $1,356.93
| Professional | | $431.04 | $715.65 | $1,356.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.20 / $759.68 / $6,679.00
| Facility | | $353.20 | $759.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.75 / $673.19 / $928.82
| Professional | | $555.75 | $673.19 | $928.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.13 / $950.96 / $1,376.65
| Professional | | $447.13 | $950.96 | $1,376.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.25 / $702.25 / $702.25
| Professional | | $702.25 | $702.25 | $702.25 |
- 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
- $532.41 / $1,012.89 / $3,502.40
| Professional | | $532.41 | $1,012.89 | $3,502.40 |
- 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
- $492.65 / $774.72 / $1,398.87
| Professional | | $492.65 | $774.72 | $1,398.87 |