- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.59 / $2,663.12 / $3,625.00
| Facility | | $385.59 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.68 / $367.09 / $607.23
| Professional | | $239.68 | $367.09 | $607.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.50 / $2,826.85 / $9,039.00
| Facility | | $594.50 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.95 / $640.04 / $2,762.72
| Professional | | $292.95 | $640.04 | $2,762.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.52 / $386.18 / $689.42
| Facility | | $300.52 | $386.18 | $689.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.33 / $599.86 / $1,019.54
| Professional | | $412.33 | $599.86 | $1,019.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.67 / $543.37 / $1,027.52
| Professional | | $321.67 | $543.37 | $1,027.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $383.59 / $6,679.00
| Facility | | $214.32 | $383.59 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.21 / $533.47 / $736.40
| Professional | | $439.21 | $533.47 | $736.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.44 / $692.45 / $1,095.95
| Professional | | $329.44 | $692.45 | $1,095.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.02 / $197.02 / $197.02
| Professional | | $197.02 | $197.02 | $197.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,290.48 / $3,764.00 / $11,500.00
| Facility | | $1,290.48 | $3,764.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.85 / $815.43 / $2,762.72
| Professional | | $421.85 | $815.43 | $2,762.72 |
- 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
- $395.05 / $636.37 / $1,150.02
| Professional | | $395.05 | $636.37 | $1,150.02 |