- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.90 / $2,425.00 / $4,767.00
| Facility | | $401.90 | $2,425.00 | $4,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.18 / $401.90 / $740.73
| Professional | | $146.18 | $401.90 | $740.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.90 / $3,764.00 / $12,379.00
| Facility | | $333.90 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.54 / $601.03 / $3,607.07
| Professional | | $153.54 | $601.03 | $3,607.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.33 / $209.73 / $412.20
| Facility | | $161.33 | $209.73 | $412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.01 / $510.55 / $1,258.39
| Professional | | $209.01 | $510.55 | $1,258.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.99 / $300.00 / $6,679.00
| Facility | | $140.99 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.58 / $436.34 / $691.61
| Professional | | $226.58 | $436.34 | $691.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.75 / $434.59 / $964.83
| Professional | | $176.75 | $434.59 | $964.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,559.85 / $2,923.51 / $6,572.28
| Facility | | $1,559.85 | $2,923.51 | $6,572.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.78 / $267.10 / $695.69
| Professional | | $109.78 | $267.10 | $695.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.61 / $4,249.00 / $16,394.00
| Facility | | $688.61 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.48 / $1,073.97 / $3,607.07
| Professional | | $459.48 | $1,073.97 | $3,607.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.63 / $760.27 / $1,465.45
| Professional | | $445.63 | $760.27 | $1,465.45 |