- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.94 / $2,618.00 / $5,003.00
| Facility | | $402.94 | $2,618.00 | $5,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.01 / $402.54 / $709.73
| Professional | | $271.01 | $402.54 | $709.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.77 / $2,854.00 / $9,039.00
| Facility | | $661.77 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.43 / $703.07 / $3,036.32
| Professional | | $320.43 | $703.07 | $3,036.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.30 / $429.58 / $766.88
| Facility | | $334.30 | $429.58 | $766.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.69 / $667.26 / $1,005.49
| Professional | | $468.69 | $667.26 | $1,005.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.51 / $620.45 / $1,139.69
| Professional | | $357.51 | $620.45 | $1,139.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.14 / $609.55 / $6,679.00
| Facility | | $289.14 | $609.55 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.43 / $585.57 / $808.32
| Professional | | $482.43 | $585.57 | $808.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.86 / $771.10 / $1,200.98
| Professional | | $366.86 | $771.10 | $1,200.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.98 / $3,764.00 / $26,542.00
| Facility | | $1,434.98 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.89 / $918.54 / $3,036.32
| Professional | | $485.89 | $918.54 | $3,036.32 |
- 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
- $462.39 / $697.20 / $1,290.77
| Professional | | $462.39 | $697.20 | $1,290.77 |