- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.13 / $2,663.12 / $5,454.00
| Facility | | $796.13 | $2,663.12 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.49 / $266.61 / $1,140.09
| Professional | | $192.49 | $266.61 | $1,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.90 / $3,997.00 / $12,379.00
| Facility | | $598.90 | $3,997.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.45 / $482.23 / $2,788.71
| Professional | | $265.45 | $482.23 | $2,788.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.32 / $469.32 / $469.32
| Professional | | $469.32 | $469.32 | $469.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.19 / $506.45 / $917.89
| Professional | | $348.19 | $506.45 | $917.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.10 / $521.84 / $6,679.00
| Facility | | $249.10 | $521.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.24 / $352.24 / $633.14
| Professional | | $280.24 | $352.24 | $633.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.14 / $608.59 / $991.74
| Professional | | $305.14 | $608.59 | $991.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,039.02 / $4,039.02 / $6,719.56
| Facility | | $4,039.02 | $4,039.02 | $6,719.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.67 / $543.15 / $543.15
| Professional | | $425.67 | $543.15 | $543.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,601.18 / $4,525.00 / $16,394.00
| Facility | | $1,601.18 | $4,525.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.20 / $521.84 / $2,788.71
| Professional | | $312.20 | $521.84 | $2,788.71 |
- 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
- $291.05 / $393.41 / $747.08
| Professional | | $291.05 | $393.41 | $747.08 |