- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.03 / $2,663.12 / $3,625.00
| Facility | | $439.03 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.42 / $413.53 / $789.89
| Professional | | $215.42 | $413.53 | $789.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.16 / $1,483.60 / $7,161.00
| Facility | | $521.16 | $1,483.60 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.89 / $719.01 / $3,217.52
| Professional | | $264.89 | $719.01 | $3,217.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.44 / $330.81 / $656.47
| Facility | | $257.44 | $330.81 | $656.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.20 / $577.55 / $1,210.59
| Professional | | $285.20 | $577.55 | $1,210.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.89 / $469.42 / $6,679.00
| Facility | | $223.89 | $469.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.21 / $638.34 / $882.60
| Professional | | $523.21 | $638.34 | $882.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.00 / $605.47 / $1,332.70
| Professional | | $286.00 | $605.47 | $1,332.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $16,394.00
| Facility | | $1,106.00 | $2,078.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.41 / $1,097.09 / $3,262.64
| Professional | | $553.41 | $1,097.09 | $3,262.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.04 / $797.89 / $1,374.24
| Professional | | $540.04 | $797.89 | $1,374.24 |