- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.16 / $2,663.12 / $4,410.00
| Facility | | $671.16 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.63 / $588.41 / $1,051.46
| Professional | | $345.63 | $588.41 | $1,051.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.03 / $2,854.00 / $9,039.00
| Facility | | $601.03 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.77 / $816.27 / $4,711.68
| Professional | | $287.77 | $816.27 | $4,711.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.58 / $375.98 / $671.20
| Facility | | $292.58 | $375.98 | $671.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.21 / $603.60 / $959.98
| Professional | | $410.21 | $603.60 | $959.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.31 / $685.03 / $1,483.42
| Professional | | $365.31 | $685.03 | $1,483.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.51 / $533.52 / $6,679.00
| Facility | | $257.51 | $533.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.54 / $517.89 / $708.00
| Professional | | $427.54 | $517.89 | $708.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.59 / $696.97 / $1,079.74
| Professional | | $331.59 | $696.97 | $1,079.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.57 / $267.02 / $1,257.77
| Professional | | $109.57 | $267.02 | $1,257.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.72 / $3,764.00 / $26,542.00
| Facility | | $1,476.72 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.16 / $1,212.84 / $4,711.68
| Professional | | $626.16 | $1,212.84 | $4,711.68 |
- 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
- $591.64 / $952.95 / $1,951.53
| Professional | | $591.64 | $952.95 | $1,951.53 |