- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.01 / $2,663.12 / $4,410.00
| Facility | | $339.01 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.51 / $294.93 / $532.59
| Professional | | $194.51 | $294.93 | $532.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.98 / $2,854.00 / $9,039.00
| Facility | | $473.98 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.01 / $566.04 / $2,555.12
| Professional | | $251.01 | $566.04 | $2,555.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.14 / $348.41 / $622.00
| Facility | | $271.14 | $348.41 | $622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.77 / $458.29 / $839.79
| Professional | | $261.77 | $458.29 | $839.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.10 / $494.40 / $6,679.00
| Facility | | $232.10 | $494.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.12 / $504.03 / $698.10
| Professional | | $413.12 | $504.03 | $698.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.32 / $623.05 / $1,024.36
| Professional | | $296.32 | $623.05 | $1,024.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.39 / $3,764.00 / $26,542.00
| Facility | | $1,154.39 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.01 / $665.95 / $2,555.12
| Professional | | $332.01 | $665.95 | $2,555.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,366.46 / $9,821.00
| Facility | | $1,902.00 | $4,366.46 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.08 / $487.52 / $1,045.61
| Professional | | $324.08 | $487.52 | $1,045.61 |