- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.85 / $1,886.00 / $3,625.00
| Facility | | $288.85 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.15 / $342.48 / $995.76
| Professional | | $153.15 | $342.48 | $995.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $861.08 / $2,733.00
| Facility | | $308.00 | $861.08 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.55 / $493.68 / $1,480.96
| Professional | | $192.55 | $493.68 | $1,480.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.21 / $261.57 / $513.09
| Facility | | $201.21 | $261.57 | $513.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.33 / $481.93 / $1,000.82
| Professional | | $256.33 | $481.93 | $1,000.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.37 / $467.93 / $1,059.40
| Professional | | $195.37 | $467.93 | $1,059.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.88 / $300.00 / $8,090.00
| Facility | | $171.88 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.60 / $558.22 / $773.29
| Professional | | $440.60 | $558.22 | $773.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.40 / $484.15 / $1,068.52
| Professional | | $213.40 | $484.15 | $1,068.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.60 / $623.04 / $638.85
| Professional | | $606.60 | $623.04 | $638.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.23 / $701.28 / $2,847.92
| Professional | | $417.23 | $701.28 | $2,847.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.70 / $549.90 / $1,072.39
| Professional | | $359.70 | $549.90 | $1,072.39 |