- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.26 / $2,663.12 / $4,410.00
| Facility | | $305.26 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.50 / $323.75 / $794.50
| Professional | | $269.50 | $323.75 | $794.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.21 / $2,826.85 / $9,039.00
| Facility | | $662.21 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.89 / $618.95 / $3,167.69
| Professional | | $303.89 | $618.95 | $3,167.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.65 / $432.60 / $772.28
| Facility | | $336.65 | $432.60 | $772.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.98 / $577.04 / $835.57
| Professional | | $403.98 | $577.04 | $835.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.52 / $515.66 / $894.75
| Professional | | $319.52 | $515.66 | $894.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.73 / $613.86 / $6,679.00
| Facility | | $290.73 | $613.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.21 / $447.23 / $613.10
| Professional | | $369.21 | $447.23 | $613.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.44 / $722.81 / $951.30
| Professional | | $351.44 | $722.81 | $951.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.81 / $312.19 / $312.19
| Professional | | $202.81 | $312.19 | $312.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.86 / $3,764.00 / $26,542.00
| Facility | | $1,443.86 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.09 / $718.38 / $3,167.69
| Professional | | $364.09 | $718.38 | $3,167.69 |
- 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
- $328.05 / $509.73 / $939.43
| Professional | | $328.05 | $509.73 | $939.43 |