- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.52 / $2,663.12 / $3,625.00
| Facility | | $517.52 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.37 / $517.52 / $1,160.03
| Professional | | $109.37 | $517.52 | $1,160.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.76 / $856.81 / $2,796.00
| Facility | | $172.76 | $856.81 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.59 / $822.37 / $2,737.74
| Professional | | $165.59 | $822.37 | $2,737.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.66 / $230.96 / $453.03
| Facility | | $177.66 | $230.96 | $453.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.94 / $554.79 / $1,152.13
| Professional | | $250.94 | $554.79 | $1,152.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.39 / $763.76 / $1,822.88
| Professional | | $274.39 | $763.76 | $1,822.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.62 / $242.97 / $6,679.00
| Facility | | $156.62 | $242.97 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.91 / $664.55 / $1,188.17
| Professional | | $558.91 | $664.55 | $1,188.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.97 / $518.23 / $1,237.50
| Professional | | $194.97 | $518.23 | $1,237.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.38 / $248.38 / $317.13
| Professional | | $248.38 | $248.38 | $317.13 |
- 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
- $745.86 / $1,677.62 / $5,400.09
| Professional | | $745.86 | $1,677.62 | $5,400.09 |
- 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
- $703.99 / $1,190.81 / $1,961.53
| Professional | | $703.99 | $1,190.81 | $1,961.53 |