- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.87 / $2,663.12 / $4,410.00
| Facility | | $386.87 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.45 / $369.06 / $601.41
| Professional | | $233.45 | $369.06 | $601.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.66 / $2,854.00 / $9,039.00
| Facility | | $591.66 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.81 / $641.84 / $2,804.16
| Professional | | $299.81 | $641.84 | $2,804.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.83 / $385.28 / $687.81
| Facility | | $299.83 | $385.28 | $687.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.68 / $563.64 / $937.52
| Professional | | $390.68 | $563.64 | $937.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.87 / $530.51 / $1,012.27
| Professional | | $318.87 | $530.51 | $1,012.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $382.69 / $6,679.00
| Facility | | $214.32 | $382.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.23 / $545.99 / $753.68
| Professional | | $448.23 | $545.99 | $753.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.15 / $689.98 / $1,122.70
| Professional | | $328.15 | $689.98 | $1,122.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.40 / $176.40 / $176.40
| Professional | | $176.40 | $176.40 | $176.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.54 / $3,764.00 / $26,542.00
| Facility | | $1,284.54 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.86 / $823.60 / $2,804.16
| Professional | | $410.86 | $823.60 | $2,804.16 |
- 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
- $380.53 / $605.38 / $1,315.84
| Professional | | $380.53 | $605.38 | $1,315.84 |