- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.35 / $2,410.00 / $3,469.00
| Facility | | $232.35 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.48 / $276.94 / $436.54
| Professional | | $206.48 | $276.94 | $436.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.63 / $1,888.98 / $16,394.00
| Facility | | $609.63 | $1,888.98 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.50 / $616.30 / $2,518.32
| Professional | | $272.50 | $616.30 | $2,518.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.57 / $375.95 / $670.57
| Facility | | $292.57 | $375.95 | $670.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $1,695.28 / $1,695.28
| Professional | | $605.88 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,111.82
| Facility | | $593.00 | $652.29 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.95 / $510.97 / $1,004.01
| Professional | | $260.95 | $510.97 | $1,004.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.48 / $533.46 / $6,679.00
| Facility | | $250.48 | $533.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.26 / $522.65 / $750.40
| Professional | | $404.26 | $522.65 | $750.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.69 / $667.13 / $1,070.14
| Professional | | $356.69 | $667.13 | $1,070.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,338.00 / $16,394.00
| Facility | | $822.00 | $2,338.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.96 / $816.00 / $2,518.32
| Professional | | $345.96 | $816.00 | $2,518.32 |
- 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
- $300.43 / $459.18 / $1,140.24
| Professional | | $300.43 | $459.18 | $1,140.24 |