- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.70 / $2,618.00 / $3,693.00
| Facility | | $475.70 | $2,618.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.76 / $472.92 / $854.34
| Professional | | $304.76 | $472.92 | $854.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.25 / $2,854.00 / $9,039.00
| Facility | | $778.25 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.44 / $799.24 / $3,514.48
| Professional | | $373.44 | $799.24 | $3,514.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.07 / $505.09 / $901.70
| Facility | | $393.07 | $505.09 | $901.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.72 / $784.57 / $1,218.46
| Professional | | $537.72 | $784.57 | $1,218.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.74 / $697.68 / $1,319.28
| Professional | | $414.74 | $697.68 | $1,319.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.24 / $716.72 / $6,679.00
| Facility | | $332.24 | $716.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.82 / $682.02 / $941.46
| Professional | | $560.82 | $682.02 | $941.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.51 / $902.84 / $1,396.68
| Professional | | $430.51 | $902.84 | $1,396.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.74 / $823.74 / $823.74
| Professional | | $823.74 | $823.74 | $823.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.78 / $3,764.00 / $16,394.00
| Facility | | $1,683.78 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.91 / $1,027.41 / $3,514.48
| Professional | | $523.91 | $1,027.41 | $3,514.48 |
- 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
- $481.35 / $753.30 / $1,607.44
| Professional | | $481.35 | $753.30 | $1,607.44 |