- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.66 / $2,663.12 / $4,410.00
| Facility | | $412.66 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.59 / $384.78 / $695.42
| Professional | | $254.59 | $384.78 | $695.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.04 / $2,854.00 / $9,039.00
| Facility | | $634.04 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.52 / $681.99 / $2,943.76
| Professional | | $313.52 | $681.99 | $2,943.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.97 / $413.73 / $738.60
| Facility | | $321.97 | $413.73 | $738.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.83 / $590.29 / $902.53
| Professional | | $410.83 | $590.29 | $902.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.82 / $568.66 / $1,092.58
| Professional | | $351.82 | $568.66 | $1,092.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $410.96 / $6,679.00
| Facility | | $214.32 | $410.96 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.99 / $572.22 / $789.89
| Professional | | $469.99 | $572.22 | $789.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.80 / $739.46 / $1,170.44
| Professional | | $351.80 | $739.46 | $1,170.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.42 / $202.42 / $202.42
| Professional | | $202.42 | $202.42 | $202.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.59 / $3,764.00 / $26,542.00
| Facility | | $1,380.59 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.89 / $862.13 / $2,943.76
| Professional | | $441.89 | $862.13 | $2,943.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.30 / $714.00 / $1,396.45
| Professional | | $425.30 | $714.00 | $1,396.45 |