- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.13 / $2,079.00 / $3,625.00
| Facility | | $286.13 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.35 / $250.18 / $419.45
| Professional | | $150.35 | $250.18 | $419.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.24 / $2,376.00 / $8,498.00
| Facility | | $406.24 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.26 / $465.87 / $2,220.64
| Professional | | $191.26 | $465.87 | $2,220.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.66 / $264.27 / $492.11
| Facility | | $205.66 | $264.27 | $492.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.41 / $412.48 / $802.33
| Professional | | $214.41 | $412.48 | $802.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.48 / $375.00 / $6,679.00
| Facility | | $175.48 | $375.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.46 / $439.78 / $612.13
| Professional | | $360.46 | $439.78 | $612.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.21 / $469.33 / $897.39
| Professional | | $223.21 | $469.33 | $897.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.59 / $3,372.00 / $12,000.00
| Facility | | $1,176.59 | $3,372.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.32 / $638.83 / $2,220.64
| Professional | | $310.32 | $638.83 | $2,220.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.26 / $486.92 / $1,099.83
| Professional | | $297.26 | $486.92 | $1,099.83 |