- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.18 / $2,618.00 / $3,625.00
| Facility | | $404.18 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.81 / $404.18 / $640.29
| Professional | | $315.81 | $404.18 | $640.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.82 / $3,764.00 / $12,379.00
| Facility | | $707.82 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.18 / $717.59 / $2,708.64
| Professional | | $307.18 | $717.59 | $2,708.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.96 / $445.85 / $786.75
| Facility | | $342.96 | $445.85 | $786.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.41 / $562.41 / $744.19
| Professional | | $562.41 | $562.41 | $744.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.75 / $745.44 / $1,403.78
| Professional | | $427.75 | $745.44 | $1,403.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.58 / $625.34 / $6,679.00
| Facility | | $293.58 | $625.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.07 / $547.23 / $972.82
| Professional | | $433.07 | $547.23 | $972.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.32 / $769.46 / $1,022.11
| Professional | | $362.32 | $769.46 | $1,022.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,249.00 / $16,394.00
| Facility | | $1,902.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.59 / $1,120.60 / $2,708.64
| Professional | | $446.59 | $1,120.60 | $2,708.64 |
- 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
- $434.73 / $601.01 / $1,444.13
| Professional | | $434.73 | $601.01 | $1,444.13 |