- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.75 / $2,663.12 / $3,625.00
| Facility | | $370.75 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.93 / $413.69 / $890.11
| Professional | | $240.93 | $413.69 | $890.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.27 / $2,854.00 / $9,039.00
| Facility | | $815.27 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.81 / $750.75 / $2,401.28
| Professional | | $366.81 | $750.75 | $2,401.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.06 / $514.88 / $908.56
| Facility | | $396.06 | $514.88 | $908.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.07 / $822.50 / $1,269.48
| Professional | | $516.07 | $822.50 | $1,269.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.83 / $752.87 / $1,534.03
| Professional | | $410.83 | $752.87 | $1,534.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.55 / $722.18 / $6,679.00
| Facility | | $333.55 | $722.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.84 / $738.44 / $1,020.54
| Professional | | $582.84 | $738.44 | $1,020.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.33 / $880.50 / $1,554.16
| Professional | | $415.33 | $880.50 | $1,554.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.21 / $3,764.00 / $16,394.00
| Facility | | $1,683.21 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.76 / $945.87 / $3,749.28
| Professional | | $510.76 | $945.87 | $3,749.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.15 / $717.17 / $1,471.28
| Professional | | $423.15 | $717.17 | $1,471.28 |