- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.17 / $2,663.12 / $3,625.00
| Facility | | $402.17 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.18 / $394.58 / $683.05
| Professional | | $250.18 | $394.58 | $683.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.48 / $2,826.85 / $9,039.00
| Facility | | $643.48 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.45 / $673.80 / $2,962.96
| Professional | | $315.45 | $673.80 | $2,962.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.15 / $422.96 / $755.07
| Facility | | $329.15 | $422.96 | $755.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.88 / $636.21 / $995.21
| Professional | | $428.88 | $636.21 | $995.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.01 / $578.49 / $1,082.56
| Professional | | $348.01 | $578.49 | $1,082.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $420.13 / $6,679.00
| Facility | | $214.32 | $420.13 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.67 / $579.12 / $800.06
| Professional | | $474.67 | $579.12 | $800.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.97 / $750.31 / $1,176.15
| Professional | | $356.97 | $750.31 | $1,176.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.37 / $354.46 / $554.40
| Professional | | $297.37 | $354.46 | $554.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.13 / $3,764.00 / $16,394.00
| Facility | | $1,412.13 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.07 / $865.48 / $2,962.96
| Professional | | $430.07 | $865.48 | $2,962.96 |
- 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
- $412.62 / $675.36 / $1,367.67
| Professional | | $412.62 | $675.36 | $1,367.67 |