- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.35 / $1,885.00 / $3,469.00
| Facility | | $662.35 | $1,885.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.63 / $457.21 / $1,302.66
| Professional | | $380.63 | $457.21 | $1,302.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,826.85 / $8,498.00
| Facility | | $941.10 | $2,826.85 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.36 / $767.14 / $4,514.43
| Professional | | $439.36 | $767.14 | $4,514.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $904.03 / $1,224.65
| Professional | | $584.90 | $904.03 | $1,224.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.83 / $736.90 / $1,283.89
| Professional | | $470.83 | $736.90 | $1,283.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.67 / $1,005.18 / $6,679.00
| Facility | | $461.67 | $1,005.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.77 / $641.72 / $884.56
| Professional | | $529.77 | $641.72 | $884.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.16 / $1,130.29 / $1,491.03
| Professional | | $570.16 | $1,130.29 | $1,491.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.12 / $1,862.12 / $2,080.98
| Facility | | $1,862.12 | $1,862.12 | $2,080.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.68 / $869.00 / $869.00
| Professional | | $716.68 | $869.00 | $869.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $16,394.00
| Facility | | $1,640.00 | $3,592.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.18 / $837.59 / $4,514.43
| Professional | | $480.18 | $837.59 | $4,514.43 |
- 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
- $472.64 / $703.63 / $1,547.69
| Professional | | $472.64 | $703.63 | $1,547.69 |