- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.20 / $1,823.00 / $3,363.00
| Facility | | $271.20 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.26 / $335.65 / $537.04
| Professional | | $259.26 | $335.65 | $537.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.37 / $1,695.92 / $4,569.00
| Facility | | $257.37 | $1,695.92 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.00 / $707.91 / $2,909.20
| Professional | | $313.00 | $707.91 | $2,909.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.02 / $426.65 / $760.99
| Facility | | $332.02 | $426.65 | $760.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.83 / $928.83 / $928.83
| Professional | | $928.83 | $928.83 | $928.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $649.47
| Facility | | $443.00 | $500.00 | $649.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.47 / $591.15 / $1,180.66
| Professional | | $293.47 | $591.15 | $1,180.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.31 / $605.40 / $6,679.00
| Facility | | $282.31 | $605.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.81 / $609.36 / $870.21
| Professional | | $468.81 | $609.36 | $870.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.75 / $745.79 / $1,096.89
| Professional | | $398.75 | $745.79 | $1,096.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,887.42 / $4,755.00
| Facility | | $55.00 | $1,887.42 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.49 / $984.22 / $2,909.20
| Professional | | $376.49 | $984.22 | $2,909.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.22 / $586.33 / $1,308.57
| Professional | | $317.22 | $586.33 | $1,308.57 |