- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.74 / $1,932.00 / $3,469.00
| Facility | | $351.74 | $1,932.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.11 / $440.37 / $694.99
| Professional | | $318.11 | $440.37 | $694.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.35 / $2,575.00 / $16,394.00
| Facility | | $813.35 | $2,575.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.28 / $825.48 / $3,250.56
| Professional | | $395.28 | $825.48 | $3,250.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.46 / $500.46 / $892.64
| Facility | | $389.46 | $500.46 | $892.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $3,212.69 / $3,212.69
| Professional | | $605.88 | $3,212.69 | $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
- $390.00 / $694.48 / $1,326.00
| Professional | | $390.00 | $694.48 | $1,326.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.56 / $710.14 / $6,679.00
| Facility | | $328.56 | $710.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.41 / $666.99 / $987.27
| Professional | | $518.41 | $666.99 | $987.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.32 / $890.31 / $1,222.99
| Professional | | $469.32 | $890.31 | $1,222.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $16,394.00
| Facility | | $1,061.00 | $2,854.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.11 / $1,118.22 / $3,250.56
| Professional | | $497.11 | $1,118.22 | $3,250.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.91 / $722.24 / $1,511.25
| Professional | | $478.91 | $722.24 | $1,511.25 |