- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.02 / $2,079.00 / $3,625.00
| Facility | | $584.02 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.52 / $432.91 / $1,283.74
| Professional | | $161.52 | $432.91 | $1,283.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $941.10 / $2,796.00
| Facility | | $308.00 | $941.10 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.61 / $812.25 / $2,480.55
| Professional | | $148.61 | $812.25 | $2,480.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.97 / $198.87 / $390.86
| Facility | | $152.97 | $198.87 | $390.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.94 / $678.58 / $1,722.30
| Professional | | $200.94 | $678.58 | $1,722.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.87 / $214.32 / $6,679.00
| Facility | | $135.87 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.19 / $585.79 / $887.08
| Professional | | $304.19 | $585.79 | $887.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.56 / $528.76 / $1,288.31
| Professional | | $172.56 | $528.76 | $1,288.31 |
- 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
- $712.86 / $1,243.90 / $3,407.60
| Professional | | $712.86 | $1,243.90 | $3,407.60 |
- 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
- $671.14 / $931.96 / $2,090.34
| Professional | | $671.14 | $931.96 | $2,090.34 |