- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.23 / $2,747.00 / $5,454.00
| Facility | | $205.23 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.23 / $264.77 / $735.72
| Professional | | $205.23 | $264.77 | $735.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,889.39 / $11,028.78
| Facility | | $818.35 | $2,889.39 | $11,028.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.03 / $876.60 / $3,236.88
| Professional | | $332.03 | $876.60 | $3,236.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.43 / $843.43 / $843.43
| Professional | | $843.43 | $843.43 | $843.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.69 / $907.44 / $1,658.04
| Professional | | $407.69 | $907.44 | $1,658.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $703.35 / $8,090.00
| Facility | | $300.00 | $703.35 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.82 / $633.02 / $937.05
| Professional | | $504.82 | $633.02 | $937.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.50 / $1,097.92 / $1,789.12
| Professional | | $550.50 | $1,097.92 | $1,789.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,715.00 / $11,217.00
| Facility | | $55.00 | $3,715.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.22 / $891.96 / $3,236.88
| Professional | | $372.22 | $891.96 | $3,236.88 |
- 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
- $344.03 / $603.16 / $1,275.05
| Professional | | $344.03 | $603.16 | $1,275.05 |