- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.94 / $2,663.12 / $4,410.00
| Facility | | $487.94 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.87 / $566.94 / $925.15
| Professional | | $332.87 | $566.94 | $925.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.62 / $3,715.00 / $9,039.00
| Facility | | $798.62 | $3,715.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.42 / $749.42 / $3,437.03
| Professional | | $363.42 | $749.42 | $3,437.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.40 / $646.21 / $872.67
| Professional | | $471.40 | $646.21 | $872.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.42 / $646.64 / $1,058.77
| Professional | | $424.42 | $646.64 | $1,058.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.69 / $716.30 / $6,679.00
| Facility | | $335.69 | $716.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.20 / $465.60 / $630.34
| Professional | | $385.20 | $465.60 | $630.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.07 / $834.73 / $1,101.14
| Professional | | $421.07 | $834.73 | $1,101.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,406.69 / $6,406.69 / $6,406.69
| Facility | | $6,406.69 | $6,406.69 | $6,406.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.93 / $1,063.34 / $2,759.95
| Professional | | $735.93 | $1,063.34 | $2,759.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.96 / $3,997.00 / $26,542.00
| Facility | | $1,896.96 | $3,997.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.19 / $810.16 / $3,437.03
| Professional | | $431.19 | $810.16 | $3,437.03 |
- 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
- $408.67 / $710.91 / $1,364.84
| Professional | | $408.67 | $710.91 | $1,364.84 |