- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.18 / $2,705.00 / $8,294.00
| Facility | | $409.18 | $2,705.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.51 / $369.76 / $706.77
| Professional | | $263.51 | $369.76 | $706.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.77 / $392.30 / $569.78
| Professional | | $275.77 | $392.30 | $569.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.45 / $307.31 / $4,716.00
| Professional | | $281.45 | $307.31 | $4,716.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.13 / $492.13 / $492.13
| Facility | | $492.13 | $492.13 | $492.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.45 / $411.75 / $747.81
| Professional | | $287.45 | $411.75 | $747.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.17 / $472.55 / $562.55
| Professional | | $424.17 | $472.55 | $562.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.05 / $401.97 / $592.46
| Facility | | $278.05 | $401.97 | $592.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.00 / $574.00 / $803.00
| Professional | | $489.00 | $574.00 | $803.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.97 / $371.88 / $5,502.98
| Facility | | $276.97 | $371.88 | $5,502.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.31 / $499.84 / $5,502.98
| Professional | | $370.31 | $499.84 | $5,502.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $6,870.00 / $12,739.00
| Facility | | $4,349.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.47 / $424.86 / $738.55
| Professional | | $303.47 | $424.86 | $738.55 |