- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.55 / $2,747.00 / $5,011.00
| Facility | | $468.55 | $2,747.00 | $5,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.77 / $468.55 / $858.25
| Professional | | $304.77 | $468.55 | $858.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.48 / $2,854.00 / $9,039.00
| Facility | | $776.48 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.25 / $789.69 / $3,464.56
| Professional | | $367.25 | $789.69 | $3,464.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.86 / $502.26 / $896.63
| Facility | | $390.86 | $502.26 | $896.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.74 / $735.00 / $1,253.25
| Professional | | $498.74 | $735.00 | $1,253.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.62 / $691.62 / $1,323.62
| Professional | | $416.62 | $691.62 | $1,323.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.02 / $712.70 / $6,679.00
| Facility | | $331.02 | $712.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.55 / $669.58 / $924.28
| Professional | | $551.55 | $669.58 | $924.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.22 / $898.42 / $1,369.96
| Professional | | $429.22 | $898.42 | $1,369.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.74 / $271.74 / $271.74
| Professional | | $271.74 | $271.74 | $271.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.61 / $3,764.00 / $26,542.00
| Facility | | $1,674.61 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.01 / $1,010.58 / $3,464.56
| Professional | | $515.01 | $1,010.58 | $3,464.56 |
- 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
- $450.14 / $723.00 / $1,433.23
| Professional | | $450.14 | $723.00 | $1,433.23 |