- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.45 / $2,410.00 / $3,469.00
| Facility | | $317.45 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.52 / $404.33 / $670.63
| Professional | | $276.52 | $404.33 | $670.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.63 / $3,728.00 / $16,394.00
| Facility | | $723.63 | $3,728.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.21 / $743.79 / $3,149.44
| Professional | | $351.21 | $743.79 | $3,149.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.16 / $449.96 / $802.57
| Facility | | $350.16 | $449.96 | $802.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.23 / $868.84 / $3,212.69
| Professional | | $574.23 | $868.84 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $6,493.89
| Facility | | $593.00 | $652.29 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.77 / $626.19 / $1,249.17
| Professional | | $340.77 | $626.19 | $1,249.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $638.48 / $6,679.00
| Facility | | $300.00 | $638.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.62 / $652.08 / $941.89
| Professional | | $504.62 | $652.08 | $941.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.75 / $800.33 / $1,186.71
| Professional | | $427.75 | $800.33 | $1,186.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $16,394.00
| Facility | | $1,591.00 | $4,006.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.11 / $1,083.40 / $3,149.44
| Professional | | $462.11 | $1,083.40 | $3,149.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.04 / $687.69 / $1,426.75
| Professional | | $427.04 | $687.69 | $1,426.75 |