- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.55 / $2,079.00 / $4,088.00
| Facility | | $415.55 | $2,079.00 | $4,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.87 / $386.69 / $935.30
| Professional | | $125.87 | $386.69 | $935.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.49 / $1,588.55 / $4,689.00
| Facility | | $379.49 | $1,588.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.25 / $1,032.15 / $3,211.13
| Professional | | $203.25 | $1,032.15 | $3,211.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.73 / $235.69 / $426.06
| Facility | | $185.73 | $235.69 | $426.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.33 / $834.23 / $1,732.45
| Professional | | $262.33 | $834.23 | $1,732.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.13 / $568.54 / $1,886.06
| Professional | | $200.13 | $568.54 | $1,886.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.51 / $254.00 / $6,679.00
| Facility | | $163.51 | $254.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.30 / $1,026.76 / $1,545.08
| Professional | | $785.30 | $1,026.76 | $1,545.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.76 / $703.63 / $1,893.85
| Professional | | $238.76 | $703.63 | $1,893.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.28 / $1,010.28 / $1,010.28
| Professional | | $1,010.28 | $1,010.28 | $1,010.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,329.00 / $4,952.00
| Facility | | $822.00 | $2,329.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.15 / $1,485.78 / $4,830.88
| Professional | | $743.15 | $1,485.78 | $4,830.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.05 / $1,091.76 / $2,158.17
| Professional | | $712.05 | $1,091.76 | $2,158.17 |