- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.32 / $2,581.76 / $3,625.00
| Facility | | $725.32 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.18 / $463.84 / $1,203.75
| Professional | | $179.18 | $463.84 | $1,203.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.76 / $3,764.00 / $12,379.00
| Facility | | $411.76 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.19 / $1,192.04 / $8,979.56
| Professional | | $215.19 | $1,192.04 | $8,979.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.97 / $256.06 / $503.26
| Facility | | $196.97 | $256.06 | $503.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.55 / $904.56 / $2,403.25
| Professional | | $257.55 | $904.56 | $2,403.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.19 / $359.16 / $6,679.00
| Facility | | $173.19 | $359.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.73 / $883.40 / $1,407.05
| Professional | | $458.73 | $883.40 | $1,407.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.31 / $868.76 / $1,928.73
| Professional | | $218.31 | $868.76 | $1,928.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.53 / $3,025.53 / $3,025.53
| Facility | | $3,025.53 | $3,025.53 | $3,025.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.90 / $4,249.00 / $16,394.00
| Facility | | $838.90 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.19 / $2,296.62 / $8,979.56
| Professional | | $882.19 | $2,296.62 | $8,979.56 |
- 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
- $642.59 / $1,274.97 / $2,731.27
| Professional | | $642.59 | $1,274.97 | $2,731.27 |