- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.61 / $2,618.00 / $3,625.00
| Facility | | $449.61 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.66 / $460.06 / $684.97
| Professional | | $390.66 | $460.06 | $684.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.65 / $2,500.00 / $9,401.00
| Facility | | $1,041.65 | $2,500.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.33 / $896.81 / $3,332.48
| Professional | | $481.33 | $896.81 | $3,332.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.65 / $2,008.65 / $2,008.65
| Professional | | $2,008.65 | $2,008.65 | $2,008.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $4,356.93
| Facility | | $593.00 | $652.29 | $4,356.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.50 / $772.26 / $1,629.64
| Professional | | $381.50 | $772.26 | $1,629.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $752.16 / $6,679.00
| Facility | | $300.00 | $752.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.58 / $676.94 / $988.58
| Professional | | $532.58 | $676.94 | $988.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.63 / $1,148.14 / $1,448.61
| Professional | | $581.63 | $1,148.14 | $1,448.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,006.00 / $11,102.00
| Facility | | $1,485.00 | $3,006.00 | $11,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.77 / $915.14 / $3,332.48
| Professional | | $485.77 | $915.14 | $3,332.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.63 / $665.54 / $1,590.42
| Professional | | $476.63 | $665.54 | $1,590.42 |