- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.43 / $2,663.12 / $3,625.00
| Facility | | $456.43 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.80 / $456.43 / $735.29
| Professional | | $283.80 | $456.43 | $735.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.75 / $3,764.00 / $12,379.00
| Facility | | $672.75 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.50 / $740.68 / $3,495.67
| Professional | | $297.50 | $740.68 | $3,495.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.08 / $425.20 / $750.32
| Facility | | $327.08 | $425.20 | $750.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.24 / $734.89 / $1,451.64
| Professional | | $397.24 | $734.89 | $1,451.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.68 / $596.40 / $6,679.00
| Facility | | $283.68 | $596.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.42 / $459.14 / $706.90
| Professional | | $238.42 | $459.14 | $706.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.92 / $758.88 / $1,048.54
| Professional | | $353.92 | $758.88 | $1,048.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,397.64 / $4,249.00 / $16,394.00
| Facility | | $1,397.64 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.78 / $1,196.15 / $3,495.67
| Professional | | $502.78 | $1,196.15 | $3,495.67 |
- 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
- $477.65 / $766.25 / $1,713.67
| Professional | | $477.65 | $766.25 | $1,713.67 |