- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.86 / $2,663.12 / $3,625.00
| Facility | | $467.86 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.39 / $441.68 / $738.12
| Professional | | $314.39 | $441.68 | $738.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.82 / $2,854.00 / $9,039.00
| Facility | | $768.82 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.64 / $780.39 / $3,598.25
| Professional | | $359.64 | $780.39 | $3,598.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.53 / $510.83 / $911.93
| Facility | | $397.53 | $510.83 | $911.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.52 / $687.04 / $1,279.74
| Professional | | $417.52 | $687.04 | $1,279.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.21 / $724.86 / $6,679.00
| Facility | | $335.21 | $724.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.34 / $647.23 / $893.43
| Professional | | $532.34 | $647.23 | $893.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.31 / $907.21 / $1,309.29
| Professional | | $427.31 | $907.21 | $1,309.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,693.95 / $3,764.00 / $16,394.00
| Facility | | $1,693.95 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.01 / $1,010.56 / $3,598.25
| Professional | | $520.01 | $1,010.56 | $3,598.25 |
- 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
- $492.98 / $756.76 / $1,583.32
| Professional | | $492.98 | $756.76 | $1,583.32 |