- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.56 / $2,083.00 / $3,625.00
| Facility | | $357.56 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.70 / $360.80 / $542.74
| Professional | | $305.70 | $360.80 | $542.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.29 / $2,308.00 / $9,401.00
| Facility | | $877.29 | $2,308.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.26 / $721.24 / $2,645.44
| Professional | | $369.26 | $721.24 | $2,645.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.65 / $2,008.65 / $2,008.65
| Professional | | $2,008.65 | $2,008.65 | $2,008.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $4,356.93
| Facility | | $443.00 | $500.00 | $4,356.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.48 / $615.88 / $1,295.64
| Professional | | $305.48 | $615.88 | $1,295.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $601.29 / $6,679.00
| Facility | | $300.00 | $601.29 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.96 / $541.16 / $786.95
| Professional | | $423.96 | $541.16 | $786.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.80 / $909.62 / $1,147.67
| Professional | | $460.80 | $909.62 | $1,147.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.48 / $3,006.00 / $11,102.00
| Facility | | $1,384.48 | $3,006.00 | $11,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.83 / $721.24 / $2,645.44
| Professional | | $381.83 | $721.24 | $2,645.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.06 / $524.86 / $1,152.88
| Professional | | $367.06 | $524.86 | $1,152.88 |