- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.44 / $1,845.24 / $3,469.00
| Facility | | $425.44 | $1,845.24 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.25 / $425.44 / $685.51
| Professional | | $271.25 | $425.44 | $685.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.25 / $2,854.00 / $9,039.00
| Facility | | $697.25 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.99 / $735.18 / $3,191.44
| Professional | | $339.99 | $735.18 | $3,191.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.11 / $452.46 / $807.74
| Facility | | $352.11 | $452.46 | $807.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.03 / $624.54 / $1,215.10
| Professional | | $372.03 | $624.54 | $1,215.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $642.02 / $6,679.00
| Facility | | $300.00 | $642.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.69 / $618.11 / $853.23
| Professional | | $508.69 | $618.11 | $853.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.64 / $812.68 / $1,269.72
| Professional | | $386.64 | $812.68 | $1,269.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.22 / $3,764.00 / $16,394.00
| Facility | | $1,508.22 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.40 / $934.85 / $3,191.44
| Professional | | $476.40 | $934.85 | $3,191.44 |
- 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
- $466.64 / $763.94 / $1,362.93
| Professional | | $466.64 | $763.94 | $1,362.93 |