- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.11 / $2,663.12 / $3,625.00
| Facility | | $450.11 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.68 / $444.17 / $767.47
| Professional | | $286.68 | $444.17 | $767.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.93 / $2,854.00 / $9,039.00
| Facility | | $729.93 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.49 / $755.85 / $3,354.56
| Professional | | $352.49 | $755.85 | $3,354.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.75 / $480.27 / $857.38
| Facility | | $373.75 | $480.27 | $857.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.56 / $654.41 / $1,226.97
| Professional | | $385.56 | $654.41 | $1,226.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.75 / $681.50 / $6,679.00
| Facility | | $315.75 | $681.50 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.60 / $651.66 / $899.55
| Professional | | $535.60 | $651.66 | $899.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.01 / $859.18 / $1,325.09
| Professional | | $409.01 | $859.18 | $1,325.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.13 / $3,764.00 / $16,394.00
| Facility | | $1,601.13 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.44 / $968.75 / $3,354.56
| Professional | | $499.44 | $968.75 | $3,354.56 |
- 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
- $475.66 / $711.17 / $1,391.49
| Professional | | $475.66 | $711.17 | $1,391.49 |