- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.61 / $1,886.00 / $3,363.00
| Facility | | $263.61 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.32 / $487.85 / $3,736.45
| Professional | | $238.32 | $487.85 | $3,736.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.45 / $1,695.92 / $4,569.00
| Facility | | $265.45 | $1,695.92 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.05 / $3,474.56 / $11,341.31
| Professional | | $334.05 | $3,474.56 | $11,341.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.30 / $352.48 / $699.47
| Facility | | $274.30 | $352.48 | $699.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.41 / $834.74 / $834.74
| Professional | | $500.41 | $834.74 | $834.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $1,408.94
| Facility | | $680.00 | $748.00 | $1,408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.43 / $760.19 / $6,949.68
| Professional | | $319.43 | $760.19 | $6,949.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.84 / $375.12 / $6,679.00
| Facility | | $234.84 | $375.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,613.87 / $3,321.51 / $4,891.77
| Professional | | $2,613.87 | $3,321.51 | $4,891.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.90 / $2,000.73 / $6,049.63
| Professional | | $352.90 | $2,000.73 | $6,049.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $4,755.00
| Facility | | $55.00 | $2,338.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.85 / $5,452.08 / $16,269.25
| Professional | | $713.85 | $5,452.08 | $16,269.25 |
- 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
- $698.72 / $3,775.67 / $9,381.20
| Professional | | $698.72 | $3,775.67 | $9,381.20 |