- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.92 / $2,618.00 / $5,454.00
| Facility | | $756.92 | $2,618.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.95 / $742.49 / $3,377.03
| Professional | | $207.95 | $742.49 | $3,377.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.87 / $3,764.00 / $12,379.00
| Facility | | $476.87 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.53 / $1,243.91 / $8,512.95
| Professional | | $217.53 | $1,243.91 | $8,512.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.59 / $295.87 / $581.49
| Facility | | $227.59 | $295.87 | $581.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.08 / $1,039.53 / $2,437.98
| Professional | | $298.08 | $1,039.53 | $2,437.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.13 / $414.98 / $6,679.00
| Facility | | $200.13 | $414.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.75 / $921.96 / $1,468.46
| Professional | | $478.75 | $921.96 | $1,468.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.32 / $909.31 / $2,018.76
| Professional | | $252.32 | $909.31 | $2,018.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,050.05 / $3,274.02 / $4,436.96
| Facility | | $3,050.05 | $3,274.02 | $4,436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.14 / $319.14 / $368.00
| Professional | | $319.14 | $319.14 | $368.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.24 / $4,249.00 / $16,394.00
| Facility | | $969.24 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.10 / $2,383.79 / $8,512.95
| Professional | | $919.10 | $2,383.79 | $8,512.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.42 / $1,255.03 / $2,754.39
| Professional | | $526.42 | $1,255.03 | $2,754.39 |