- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.71 / $2,079.00 / $3,625.00
| Facility | | $344.71 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.95 / $365.70 / $589.76
| Professional | | $308.95 | $365.70 | $589.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,376.00 / $8,908.95
| Facility | | $822.00 | $2,376.00 | $8,908.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.44 / $704.54 / $2,826.96
| Professional | | $339.44 | $704.54 | $2,826.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.32 / $547.82 / $977.98
| Facility | | $426.32 | $547.82 | $977.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.32 / $624.38 / $1,070.13
| Professional | | $371.32 | $624.38 | $1,070.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.14 / $777.34 / $6,679.00
| Facility | | $355.14 | $777.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.57 / $555.79 / $767.20
| Professional | | $455.57 | $555.79 | $767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.04 / $896.37 / $1,183.80
| Professional | | $437.04 | $896.37 | $1,183.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $12,000.00
| Facility | | $1,640.00 | $3,372.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.02 / $760.10 / $2,826.96
| Professional | | $378.02 | $760.10 | $2,826.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.65 / $555.20 / $1,229.96
| Professional | | $347.65 | $555.20 | $1,229.96 |