- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.08 / $2,663.12 / $4,767.00
| Facility | | $432.08 | $2,663.12 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.87 / $418.43 / $760.79
| Professional | | $271.87 | $418.43 | $760.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.49 / $2,826.85 / $9,039.00
| Facility | | $685.49 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.05 / $717.47 / $3,145.60
| Professional | | $333.05 | $717.47 | $3,145.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.90 / $447.05 / $798.08
| Facility | | $347.90 | $447.05 | $798.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.93 / $669.35 / $1,089.36
| Professional | | $475.93 | $669.35 | $1,089.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.99 / $614.46 / $1,175.47
| Professional | | $369.99 | $614.46 | $1,175.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $444.05 / $6,679.00
| Facility | | $214.32 | $444.05 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.40 / $609.77 / $841.72
| Professional | | $501.40 | $609.77 | $841.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.62 / $800.04 / $1,243.95
| Professional | | $380.62 | $800.04 | $1,243.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.91 / $410.91 / $787.12
| Professional | | $410.91 | $410.91 | $787.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.17 / $3,764.00 / $16,394.00
| Facility | | $1,492.17 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.54 / $914.78 / $3,145.60
| Professional | | $463.54 | $914.78 | $3,145.60 |
- 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
- $426.15 / $669.41 / $1,306.33
| Professional | | $426.15 | $669.41 | $1,306.33 |