- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.45 / $2,618.00 / $3,625.00
| Facility | | $293.45 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.50 / $293.45 / $553.80
| Professional | | $201.50 | $293.45 | $553.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.01 / $3,372.00 / $10,821.00
| Facility | | $463.01 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.21 / $520.04 / $2,452.58
| Professional | | $211.21 | $520.04 | $2,452.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.12 / $291.36 / $514.13
| Facility | | $224.12 | $291.36 | $514.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.52 / $652.35 / $1,233.24
| Professional | | $285.52 | $652.35 | $1,233.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.33 / $540.20 / $1,011.20
| Professional | | $288.33 | $540.20 | $1,011.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.89 / $408.66 / $6,679.00
| Facility | | $195.89 | $408.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.11 / $381.44 / $614.96
| Professional | | $208.11 | $381.44 | $614.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.45 / $530.84 / $905.71
| Professional | | $246.45 | $530.84 | $905.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.09 / $3,649.00 / $16,394.00
| Facility | | $954.09 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.56 / $883.55 / $2,452.58
| Professional | | $379.56 | $883.55 | $2,452.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.58 / $507.35 / $1,129.85
| Professional | | $344.58 | $507.35 | $1,129.85 |