- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.26 / $782.72 / $7,724.00
| Facility | | $337.26 | $782.72 | $7,724.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.72 / $465.08 / $785.12
| Professional | | $326.72 | $465.08 | $785.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.30 / $1,311.30 / $1,330.43
| Facility | | $1,311.30 | $1,311.30 | $1,330.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.27 / $650.79 / $1,202.24
| Professional | | $428.27 | $650.79 | $1,202.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.25 / $572.55 / $1,058.02
| Professional | | $391.25 | $572.55 | $1,058.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.26 / $571.47 / $855.32
| Facility | | $337.26 | $571.47 | $855.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $625.00 / $625.00
| Professional | | $579.00 | $625.00 | $625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $632.60 / $1,357.40
| Professional | | $3.00 | $632.60 | $1,357.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.83 / $583.12 / $1,159.73
| Professional | | $409.83 | $583.12 | $1,159.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,623.52 / $1,785.48 / $26,542.00
| Facility | | $1,623.52 | $1,785.48 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,591.04 / $3,502.40 / $4,022.63
| Professional | | $2,591.04 | $3,502.40 | $4,022.63 |