- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.09 / $2,663.12 / $3,625.00
| Facility | | $367.09 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.26 / $351.21 / $583.66
| Professional | | $222.26 | $351.21 | $583.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.45 / $2,854.00 / $9,039.00
| Facility | | $555.45 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.10 / $600.27 / $2,650.56
| Professional | | $281.10 | $600.27 | $2,650.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.86 / $362.19 / $646.59
| Facility | | $281.86 | $362.19 | $646.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.33 / $522.29 / $958.38
| Professional | | $305.33 | $522.29 | $958.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.36 / $513.94 / $6,679.00
| Facility | | $243.36 | $513.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.26 / $513.75 / $709.17
| Professional | | $422.26 | $513.75 | $709.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.36 / $648.39 / $1,049.20
| Professional | | $308.36 | $648.39 | $1,049.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.30 / $3,764.00 / $16,394.00
| Facility | | $1,210.30 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.90 / $805.88 / $2,650.56
| Professional | | $414.90 | $805.88 | $2,650.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,366.46 / $9,821.00
| Facility | | $1,902.00 | $4,366.46 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.64 / $589.66 / $1,104.41
| Professional | | $374.64 | $589.66 | $1,104.41 |