- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.98 / $2,747.00 / $4,806.64
| Facility | | $295.98 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.98 / $464.22 / $740.72
| Professional | | $295.98 | $464.22 | $740.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.49 / $2,575.00 / $5,454.00
| Facility | | $702.49 | $2,575.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.85 / $644.64 / $2,137.28
| Professional | | $330.85 | $644.64 | $2,137.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.06 / $458.98 / $809.92
| Facility | | $353.06 | $458.98 | $809.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.35 / $448.35 / $1,316.29
| Professional | | $448.35 | $448.35 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.83 / $633.78 / $1,222.55
| Professional | | $302.83 | $633.78 | $1,222.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $643.76 / $6,679.00
| Facility | | $300.00 | $643.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.66 / $634.33 / $879.98
| Professional | | $500.66 | $634.33 | $879.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.45 / $789.26 / $1,435.32
| Professional | | $360.45 | $789.26 | $1,435.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.22 / $754.71 / $3,234.80
| Professional | | $468.22 | $754.71 | $3,234.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.71 / $653.35 / $1,326.53
| Professional | | $456.71 | $653.35 | $1,326.53 |