- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.03 / $2,663.12 / $3,693.00
| Facility | | $389.03 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.14 / $427.48 / $823.07
| Professional | | $294.14 | $427.48 | $823.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.44 / $2,854.00 / $9,039.00
| Facility | | $911.44 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.33 / $771.62 / $2,798.72
| Professional | | $384.33 | $771.62 | $2,798.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.54 / $585.70 / $1,033.54
| Facility | | $450.54 | $585.70 | $1,033.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.61 / $893.42 / $1,304.57
| Professional | | $599.61 | $893.42 | $1,304.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.46 / $733.26 / $1,447.35
| Professional | | $437.46 | $733.26 | $1,447.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.11 / $821.52 / $6,679.00
| Facility | | $383.11 | $821.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.46 / $696.99 / $962.12
| Professional | | $556.46 | $696.99 | $962.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.00 / $1,000.26 / $1,548.58
| Professional | | $478.00 | $1,000.26 | $1,548.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,867.80 / $5,034.51 / $6,625.16
| Facility | | $2,867.80 | $5,034.51 | $6,625.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $16,394.00
| Facility | | $1,902.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.50 / $966.53 / $3,636.16
| Professional | | $552.50 | $966.53 | $3,636.16 |
- 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
- $454.86 / $701.42 / $1,349.21
| Professional | | $454.86 | $701.42 | $1,349.21 |