- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.41 / $2,663.12 / $4,712.00
| Facility | | $501.41 | $2,663.12 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.08 / $476.46 / $819.18
| Professional | | $315.08 | $476.46 | $819.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.64 / $2,854.00 / $9,039.00
| Facility | | $773.64 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.26 / $799.57 / $3,537.92
| Professional | | $376.26 | $799.57 | $3,537.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.12 / $502.59 / $897.23
| Facility | | $391.12 | $502.59 | $897.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.68 / $698.99 / $1,311.69
| Professional | | $413.68 | $698.99 | $1,311.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.39 / $713.16 / $6,679.00
| Facility | | $330.39 | $713.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.40 / $688.14 / $949.91
| Professional | | $565.40 | $688.14 | $949.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.36 / $900.37 / $1,408.16
| Professional | | $428.36 | $900.37 | $1,408.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.62 / $191.62 / $191.62
| Professional | | $191.62 | $191.62 | $191.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.38 / $3,764.00 / $26,542.00
| Facility | | $1,674.38 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.11 / $1,045.24 / $3,537.92
| Professional | | $537.11 | $1,045.24 | $3,537.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.54 / $781.79 / $1,478.49
| Professional | | $495.54 | $781.79 | $1,478.49 |