- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.55 / $2,663.12 / $3,625.00
| Facility | | $430.55 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.35 / $378.83 / $673.53
| Professional | | $248.35 | $378.83 | $673.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.46 / $2,854.00 / $9,039.00
| Facility | | $604.46 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.72 / $657.88 / $2,815.68
| Professional | | $297.72 | $657.88 | $2,815.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.27 / $392.28 / $700.31
| Facility | | $305.27 | $392.28 | $700.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.78 / $575.04 / $1,105.80
| Professional | | $341.78 | $575.04 | $1,105.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.18 / $556.64 / $6,679.00
| Facility | | $264.18 | $556.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.25 / $542.95 / $749.48
| Professional | | $447.25 | $542.95 | $749.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.03 / $704.46 / $1,116.02
| Professional | | $335.03 | $704.46 | $1,116.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.05 / $3,764.00 / $16,394.00
| Facility | | $1,311.05 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.05 / $886.90 / $2,815.68
| Professional | | $472.05 | $886.90 | $2,815.68 |
- 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
- $447.36 / $684.19 / $1,273.01
| Professional | | $447.36 | $684.19 | $1,273.01 |