- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.07 / $2,618.00 / $3,625.00
| Facility | | $420.07 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.33 / $420.07 / $688.51
| Professional | | $326.33 | $420.07 | $688.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.40 / $3,764.00 / $12,379.00
| Facility | | $754.40 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.64 / $771.67 / $2,914.72
| Professional | | $322.64 | $771.67 | $2,914.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.99 / $475.79 / $839.58
| Facility | | $365.99 | $475.79 | $839.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.19 / $600.19 / $802.16
| Professional | | $600.19 | $600.19 | $802.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.51 / $790.34 / $1,451.15
| Professional | | $441.51 | $790.34 | $1,451.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $667.34 / $6,679.00
| Facility | | $307.20 | $667.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.72 / $589.76 / $1,020.13
| Professional | | $466.72 | $589.76 | $1,020.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.51 / $824.26 / $1,103.03
| Professional | | $387.51 | $824.26 | $1,103.03 |
- 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
- $470.40 / $1,219.84 / $2,914.72
| Professional | | $470.40 | $1,219.84 | $2,914.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.95 / $631.71 / $1,517.52
| Professional | | $467.95 | $631.71 | $1,517.52 |