- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.53 / $2,663.12 / $3,625.00
| Facility | | $370.53 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.55 / $370.53 / $587.69
| Professional | | $238.55 | $370.53 | $587.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.91 / $2,575.00 / $5,454.00
| Facility | | $522.91 | $2,575.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.45 / $522.63 / $1,706.48
| Professional | | $256.45 | $522.63 | $1,706.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.66 / $355.76 / $627.78
| Facility | | $273.66 | $355.76 | $627.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.67 / $563.44 / $918.44
| Professional | | $383.67 | $563.44 | $918.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.69 / $296.69 / $296.69
| Facility | | $296.69 | $296.69 | $296.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.95 / $550.55 / $979.42
| Professional | | $285.95 | $550.55 | $979.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.85 / $499.00 / $6,679.00
| Facility | | $236.85 | $499.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.15 / $514.09 / $709.65
| Professional | | $407.15 | $514.09 | $709.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.72 / $630.15 / $1,175.04
| Professional | | $286.72 | $630.15 | $1,175.04 |
- 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
- $396.00 / $690.95 / $3,645.68
| Professional | | $396.00 | $690.95 | $3,645.68 |
- 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
- $390.17 / $539.46 / $1,146.28
| Professional | | $390.17 | $539.46 | $1,146.28 |