- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.79 / $2,663.12 / $3,625.00
| Facility | | $447.79 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.61 / $390.52 / $737.54
| Professional | | $199.61 | $390.52 | $737.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.22 / $2,078.00 / $7,958.00
| Facility | | $666.22 | $2,078.00 | $7,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.77 / $667.06 / $4,954.00
| Professional | | $306.77 | $667.06 | $4,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.87 / $434.03 / $765.90
| Facility | | $333.87 | $434.03 | $765.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.09 / $666.40 / $1,002.05
| Professional | | $468.09 | $666.40 | $1,002.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.80 / $667.98 / $1,285.53
| Professional | | $351.80 | $667.98 | $1,285.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.13 / $608.78 / $6,679.00
| Facility | | $291.13 | $608.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.42 / $467.00 / $750.25
| Professional | | $252.42 | $467.00 | $750.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.53 / $782.22 / $1,104.85
| Professional | | $414.53 | $782.22 | $1,104.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.14 / $433.14 / $433.14
| Professional | | $433.14 | $433.14 | $433.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,430.00 / $16,394.00
| Facility | | $1,106.00 | $2,430.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.32 / $838.94 / $4,954.00
| Professional | | $467.32 | $838.94 | $4,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.90 / $608.42 / $1,467.86
| Professional | | $448.90 | $608.42 | $1,467.86 |