- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.64 / $2,079.00 / $3,625.00
| Facility | | $410.64 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.34 / $372.79 / $649.12
| Professional | | $217.34 | $372.79 | $649.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.99 / $1,483.60 / $7,161.00
| Facility | | $542.99 | $1,483.60 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.72 / $699.66 / $3,403.92
| Professional | | $258.72 | $699.66 | $3,403.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.38 / $361.57 / $717.52
| Facility | | $281.38 | $361.57 | $717.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.91 / $625.09 / $1,293.05
| Professional | | $404.91 | $625.09 | $1,293.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.26 / $593.59 / $1,176.71
| Professional | | $294.26 | $593.59 | $1,176.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.78 / $513.05 / $6,679.00
| Facility | | $242.78 | $513.05 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.96 / $673.41 / $933.96
| Professional | | $551.96 | $673.41 | $933.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.52 / $662.92 / $1,414.41
| Professional | | $313.52 | $662.92 | $1,414.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $12,000.00
| Facility | | $1,106.00 | $2,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.54 / $995.54 / $3,403.92
| Professional | | $518.54 | $995.54 | $3,403.92 |
- 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
- $481.40 / $742.92 / $1,449.02
| Professional | | $481.40 | $742.92 | $1,449.02 |