- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.50 / $2,497.00 / $4,410.00
| Facility | | $425.50 | $2,497.00 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.69 / $414.28 / $746.82
| Professional | | $274.69 | $414.28 | $746.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.65 / $2,854.00 / $9,039.00
| Facility | | $699.65 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.16 / $715.68 / $3,099.04
| Professional | | $328.16 | $715.68 | $3,099.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.46 / $452.91 / $808.54
| Facility | | $352.46 | $452.91 | $808.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.58 / $697.28 / $942.07
| Professional | | $483.58 | $697.28 | $942.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.86 / $621.65 / $1,194.04
| Professional | | $375.86 | $621.65 | $1,194.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $642.67 / $6,679.00
| Facility | | $300.00 | $642.67 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.46 / $597.29 / $824.51
| Professional | | $492.46 | $597.29 | $824.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.07 / $810.20 / $1,224.85
| Professional | | $387.07 | $810.20 | $1,224.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,267.18 / $4,267.18 / $4,267.18
| Facility | | $4,267.18 | $4,267.18 | $4,267.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.36 / $3,764.00 / $26,542.00
| Facility | | $1,511.36 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.68 / $907.35 / $3,099.04
| Professional | | $473.68 | $907.35 | $3,099.04 |
- 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
- $438.28 / $671.95 / $1,281.01
| Professional | | $438.28 | $671.95 | $1,281.01 |