- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.66 / $2,083.00 / $3,625.00
| Facility | | $257.66 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.44 / $261.95 / $389.99
| Professional | | $241.44 | $261.95 | $389.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.23 / $2,329.00 / $10,616.00
| Facility | | $286.23 | $2,329.00 | $10,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.83 / $440.44 / $1,872.16
| Professional | | $272.83 | $440.44 | $1,872.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.41 / $3,830.42 / $3,830.42
| Professional | | $500.41 | $3,830.42 | $3,830.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $6,019.56
| Facility | | $680.00 | $748.00 | $6,019.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.25 / $450.38 / $897.45
| Professional | | $285.25 | $450.38 | $897.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.20 / $404.36 / $6,679.00
| Facility | | $253.20 | $404.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.55 / $363.92 / $525.66
| Professional | | $290.55 | $363.92 | $525.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.80 / $623.39 / $786.53
| Professional | | $315.80 | $623.39 | $786.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,866.13 / $10,821.00
| Facility | | $55.00 | $1,866.13 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.48 / $452.43 / $1,872.16
| Professional | | $286.48 | $452.43 | $1,872.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,372.00 / $8,498.00
| Facility | | $822.00 | $3,372.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.07 / $398.40 / $885.33
| Professional | | $281.07 | $398.40 | $885.33 |