- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.17 / $2,079.00 / $3,625.00
| Facility | | $389.17 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.28 / $362.30 / $635.51
| Professional | | $254.28 | $362.30 | $635.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.03 / $2,575.00 / $5,714.00
| Facility | | $438.03 | $2,575.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.02 / $634.91 / $2,720.40
| Professional | | $292.02 | $634.91 | $2,720.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.66 / $406.91 / $726.42
| Facility | | $316.66 | $406.91 | $726.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $567.22 / $1,068.01
| Professional | | $338.84 | $567.22 | $1,068.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.35 / $577.40 / $6,679.00
| Facility | | $271.35 | $577.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.63 / $531.48 / $733.67
| Professional | | $435.63 | $531.48 | $733.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.20 / $718.37 / $1,069.23
| Professional | | $343.20 | $718.37 | $1,069.23 |
- 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
- $402.04 / $817.98 / $2,720.40
| Professional | | $402.04 | $817.98 | $2,720.40 |
- 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
- $372.47 / $598.84 / $1,323.99
| Professional | | $372.47 | $598.84 | $1,323.99 |