- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.98 / $2,663.12 / $4,410.00
| Facility | | $355.98 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.31 / $355.98 / $763.70
| Professional | | $234.31 | $355.98 | $763.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.97 / $3,764.00 / $12,379.00
| Facility | | $796.97 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.81 / $822.74 / $3,355.46
| Professional | | $356.81 | $822.74 | $3,355.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.80 / $506.74 / $894.20
| Facility | | $389.80 | $506.74 | $894.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.41 / $878.52 / $1,656.82
| Professional | | $538.41 | $878.52 | $1,656.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.63 / $710.76 / $6,679.00
| Facility | | $326.63 | $710.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.09 / $659.72 / $1,102.55
| Professional | | $522.09 | $659.72 | $1,102.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.48 / $893.01 / $1,317.51
| Professional | | $416.48 | $893.01 | $1,317.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.00 / $4,249.00 / $26,542.00
| Facility | | $1,655.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.24 / $1,208.65 / $3,355.46
| Professional | | $535.24 | $1,208.65 | $3,355.46 |
- 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
- $498.51 / $908.89 / $1,491.65
| Professional | | $498.51 | $908.89 | $1,491.65 |