- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.28 / $2,663.12 / $3,625.00
| Facility | | $471.28 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.67 / $403.70 / $721.34
| Professional | | $270.67 | $403.70 | $721.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.98 / $2,854.00 / $9,039.00
| Facility | | $660.98 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $696.80 / $3,220.80
| Professional | | $318.05 | $696.80 | $3,220.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.93 / $429.10 / $766.04
| Facility | | $333.93 | $429.10 | $766.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.08 / $614.91 / $1,136.81
| Professional | | $357.08 | $614.91 | $1,136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.82 / $608.88 / $6,679.00
| Facility | | $288.82 | $608.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.90 / $581.17 / $802.26
| Professional | | $478.90 | $581.17 | $802.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.43 / $768.30 / $1,191.42
| Professional | | $366.43 | $768.30 | $1,191.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.41 / $3,764.00 / $16,394.00
| Facility | | $1,433.41 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.03 / $911.66 / $3,220.80
| Professional | | $469.03 | $911.66 | $3,220.80 |
- 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
- $443.94 / $720.36 / $1,421.27
| Professional | | $443.94 | $720.36 | $1,421.27 |