- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.82 / $2,563.40 / $3,625.00
| Facility | | $435.82 | $2,563.40 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.74 / $435.82 / $1,162.29
| Professional | | $281.74 | $435.82 | $1,162.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.39 / $3,764.00 / $12,379.00
| Facility | | $648.39 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.25 / $726.89 / $4,922.22
| Professional | | $313.25 | $726.89 | $4,922.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.33 / $403.43 / $711.90
| Facility | | $310.33 | $403.43 | $711.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.67 / $753.41 / $1,457.64
| Professional | | $403.67 | $753.41 | $1,457.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.89 / $565.84 / $6,679.00
| Facility | | $271.89 | $565.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.64 / $542.38 / $834.09
| Professional | | $281.64 | $542.38 | $834.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.75 / $736.10 / $1,228.54
| Professional | | $341.75 | $736.10 | $1,228.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,103.34 / $3,103.34 / $3,103.34
| Facility | | $3,103.34 | $3,103.34 | $3,103.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.10 / $412.10 / $434.68
| Professional | | $412.10 | $412.10 | $434.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.08 / $4,249.00 / $16,394.00
| Facility | | $1,424.08 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.78 / $1,179.99 / $4,922.22
| Professional | | $543.78 | $1,179.99 | $4,922.22 |
- 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
- $488.77 / $724.71 / $1,646.80
| Professional | | $488.77 | $724.71 | $1,646.80 |