- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.42 / $2,079.00 / $3,685.00
| Facility | | $398.42 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.50 / $389.16 / $653.60
| Professional | | $242.50 | $389.16 | $653.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.70 / $2,854.00 / $9,039.00
| Facility | | $629.70 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.57 / $675.09 / $2,983.52
| Professional | | $317.57 | $675.09 | $2,983.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.29 / $411.57 / $734.75
| Facility | | $320.29 | $411.57 | $734.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.34 / $600.42 / $917.36
| Professional | | $417.34 | $600.42 | $917.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.55 / $564.92 / $1,086.10
| Professional | | $335.55 | $564.92 | $1,086.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.70 / $584.02 / $6,679.00
| Facility | | $275.70 | $584.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.14 / $581.63 / $802.88
| Professional | | $477.14 | $581.63 | $802.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.65 / $735.20 / $1,184.76
| Professional | | $349.65 | $735.20 | $1,184.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.43 / $1,095.43 / $1,095.43
| Facility | | $1,095.43 | $1,095.43 | $1,095.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,372.99 / $3,764.00 / $12,000.00
| Facility | | $1,372.99 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.37 / $862.92 / $2,983.52
| Professional | | $421.37 | $862.92 | $2,983.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.25 / $638.71 / $1,261.94
| Professional | | $386.25 | $638.71 | $1,261.94 |