- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.34 / $2,663.12 / $4,410.00
| Facility | | $403.34 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.85 / $390.88 / $623.90
| Professional | | $248.85 | $390.88 | $623.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.94 / $2,826.85 / $9,039.00
| Facility | | $628.94 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.63 / $673.27 / $2,906.08
| Professional | | $311.63 | $673.27 | $2,906.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.32 / $407.76 / $727.93
| Facility | | $317.32 | $407.76 | $727.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.09 / $633.37 / $1,057.22
| Professional | | $434.09 | $633.37 | $1,057.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.46 / $564.25 / $1,083.45
| Professional | | $337.46 | $564.25 | $1,083.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $405.02 / $6,679.00
| Facility | | $214.32 | $405.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.82 / $564.85 / $779.72
| Professional | | $463.82 | $564.85 | $779.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.22 / $727.98 / $1,159.94
| Professional | | $346.22 | $727.98 | $1,159.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.73 / $3,764.00 / $26,542.00
| Facility | | $1,361.73 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.42 / $858.35 / $2,906.08
| Professional | | $423.42 | $858.35 | $2,906.08 |
- 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
- $415.30 / $652.20 / $1,221.59
| Professional | | $415.30 | $652.20 | $1,221.59 |