- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.22 / $2,670.00 / $4,806.64
| Facility | | $259.22 | $2,670.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.57 / $295.50 / $813.14
| Professional | | $155.57 | $295.50 | $813.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.23 / $3,372.00 / $10,821.00
| Facility | | $358.23 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.75 / $453.35 / $2,544.21
| Professional | | $172.75 | $453.35 | $2,544.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.74 / $224.56 / $440.49
| Facility | | $172.74 | $224.56 | $440.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.00 / $434.36 / $757.37
| Professional | | $244.00 | $434.36 | $757.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.39 / $468.11 / $912.86
| Professional | | $223.39 | $468.11 | $912.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.77 / $410.09 / $822.06
| Professional | | $189.77 | $410.09 | $822.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.28 / $2,483.85 / $4,056.00
| Facility | | $822.28 | $2,483.85 | $4,056.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.35 / $441.76 / $505.00
| Professional | | $227.35 | $441.76 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.49 / $3,649.00 / $16,394.00
| Facility | | $736.49 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.16 / $806.35 / $2,544.21
| Professional | | $340.16 | $806.35 | $2,544.21 |
- 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
- $331.48 / $463.72 / $1,004.29
| Professional | | $331.48 | $463.72 | $1,004.29 |