- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.98 / $2,410.00 / $3,469.00
| Facility | | $255.98 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.50 / $319.33 / $470.39
| Professional | | $245.50 | $319.33 | $470.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.89 / $2,575.00 / $16,394.00
| Facility | | $635.89 | $2,575.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.77 / $623.77 / $2,372.00
| Professional | | $302.77 | $623.77 | $2,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.80 / $391.67 / $698.60
| Facility | | $304.80 | $391.67 | $698.60 |
- 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
- $300.79 / $507.89 / $978.76
| Professional | | $300.79 | $507.89 | $978.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.23 / $555.78 / $6,679.00
| Facility | | $263.23 | $555.78 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.26 / $482.83 / $709.49
| Professional | | $377.26 | $482.83 | $709.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.98 / $692.81 / $896.37
| Professional | | $343.98 | $692.81 | $896.37 |
- 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
- $375.94 / $788.89 / $2,372.00
| Professional | | $375.94 | $788.89 | $2,372.00 |
- 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
- $344.68 / $502.84 / $1,273.58
| Professional | | $344.68 | $502.84 | $1,273.58 |