- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.46 / $2,663.12 / $3,625.00
| Facility | | $497.46 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.21 / $497.46 / $722.94
| Professional | | $358.21 | $497.46 | $722.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.74 / $2,854.00 / $9,039.00
| Facility | | $834.74 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.03 / $764.59 / $3,112.00
| Professional | | $379.03 | $764.59 | $3,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.84 / $543.19 / $958.52
| Facility | | $417.84 | $543.19 | $958.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.94 / $747.65 / $1,558.38
| Professional | | $452.94 | $747.65 | $1,558.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.30 / $761.90 / $6,679.00
| Facility | | $352.30 | $761.90 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.01 / $687.12 / $948.50
| Professional | | $544.01 | $687.12 | $948.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.40 / $913.60 / $1,447.86
| Professional | | $435.40 | $913.60 | $1,447.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $16,394.00
| Facility | | $1,902.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.20 / $962.23 / $3,532.24
| Professional | | $578.20 | $962.23 | $3,532.24 |
- 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
- $537.29 / $754.49 / $1,477.59
| Professional | | $537.29 | $754.49 | $1,477.59 |