- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.26 / $2,618.00 / $3,625.00
| Facility | | $291.26 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.12 / $295.45 / $656.87
| Professional | | $263.12 | $295.45 | $656.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.07 / $2,338.00 / $16,394.00
| Facility | | $618.07 | $2,338.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.29 / $557.27 / $2,230.64
| Professional | | $300.29 | $557.27 | $2,230.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.62 / $537.49 / $751.76
| Professional | | $355.62 | $537.49 | $751.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $1,923.56
| Facility | | $593.00 | $652.29 | $1,923.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.55 / $498.11 / $973.74
| Professional | | $313.55 | $498.11 | $973.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.98 / $586.29 / $6,679.00
| Facility | | $280.98 | $586.29 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.10 / $399.43 / $637.25
| Professional | | $316.10 | $399.43 | $637.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.65 / $678.37 / $855.89
| Professional | | $343.65 | $678.37 | $855.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,649.00 / $16,394.00
| Facility | | $822.00 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.92 / $559.95 / $2,230.64
| Professional | | $319.92 | $559.95 | $2,230.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.93 / $436.92 / $1,005.65
| Professional | | $295.93 | $436.92 | $1,005.65 |