- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.88 / $2,079.00 / $3,625.00
| Facility | | $533.88 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.31 / $387.08 / $997.78
| Professional | | $84.31 | $387.08 | $997.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.91 / $736.00 / $2,796.00
| Facility | | $155.91 | $736.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.32 / $938.70 / $2,457.62
| Professional | | $149.32 | $938.70 | $2,457.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.96 / $209.25 / $410.45
| Facility | | $160.96 | $209.25 | $410.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.36 / $693.94 / $1,245.55
| Professional | | $227.36 | $693.94 | $1,245.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.22 / $751.88 / $2,136.48
| Professional | | $238.22 | $751.88 | $2,136.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.97 / $220.13 / $6,679.00
| Facility | | $141.97 | $220.13 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.10 / $826.36 / $1,477.47
| Professional | | $699.10 | $826.36 | $1,477.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.13 / $586.65 / $1,528.75
| Professional | | $176.13 | $586.65 | $1,528.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.96 / $1,535.12 / $4,026.48
| Professional | | $900.96 | $1,535.12 | $4,026.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.10 / $1,189.98 / $2,457.62
| Professional | | $839.10 | $1,189.98 | $2,457.62 |