- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.73 / $2,663.12 / $3,625.00
| Facility | | $425.73 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.58 / $419.74 / $723.73
| Professional | | $266.58 | $419.74 | $723.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.45 / $2,826.85 / $9,039.00
| Facility | | $677.45 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.64 / $714.22 / $3,126.72
| Professional | | $332.64 | $714.22 | $3,126.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.15 / $439.66 / $784.89
| Facility | | $342.15 | $439.66 | $784.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.06 / $682.93 / $1,157.29
| Professional | | $468.06 | $682.93 | $1,157.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.15 / $606.79 / $1,154.42
| Professional | | $362.15 | $606.79 | $1,154.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $436.72 / $6,679.00
| Facility | | $214.32 | $436.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.24 / $605.55 / $835.91
| Professional | | $498.24 | $605.55 | $835.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.46 / $789.18 / $1,238.21
| Professional | | $375.46 | $789.18 | $1,238.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.44 / $614.52 / $745.29
| Professional | | $204.44 | $614.52 | $745.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.42 / $3,764.00 / $11,500.00
| Facility | | $1,466.42 | $3,764.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.32 / $914.41 / $3,126.72
| Professional | | $472.32 | $914.41 | $3,126.72 |
- 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
- $451.07 / $738.45 / $1,448.71
| Professional | | $451.07 | $738.45 | $1,448.71 |