- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.45 / $2,663.12 / $3,625.00
| Facility | | $392.45 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.55 / $422.24 / $645.03
| Professional | | $339.55 | $422.24 | $645.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.32 / $1,267.00 / $7,161.00
| Facility | | $795.32 | $1,267.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.36 / $541.83 / $2,555.84
| Professional | | $295.36 | $541.83 | $2,555.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.58 / $542.02 / $957.93
| Facility | | $417.58 | $542.02 | $957.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.40 / $733.53 / $1,001.84
| Professional | | $527.40 | $733.53 | $1,001.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.47 / $386.47 / $386.47
| Facility | | $386.47 | $386.47 | $386.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.33 / $680.86 / $1,232.72
| Professional | | $341.33 | $680.86 | $1,232.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.99 / $761.42 / $6,679.00
| Facility | | $350.99 | $761.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.15 / $535.26 / $738.87
| Professional | | $426.15 | $535.26 | $738.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.08 / $882.09 / $1,174.19
| Professional | | $430.08 | $882.09 | $1,174.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,510.00 / $16,394.00
| Facility | | $789.00 | $2,510.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.85 / $649.41 / $2,796.80
| Professional | | $387.85 | $649.41 | $2,796.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,078.00 / $5,683.00
| Facility | | $700.00 | $2,078.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.17 / $538.12 / $1,203.81
| Professional | | $381.17 | $538.12 | $1,203.81 |