- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.64 / $2,663.12 / $4,410.00
| Facility | | $325.64 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.70 / $334.96 / $781.92
| Professional | | $303.70 | $334.96 | $781.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.62 / $3,764.00 / $12,379.00
| Facility | | $779.62 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.27 / $684.02 / $3,031.43
| Professional | | $321.27 | $684.02 | $3,031.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.10 / $482.99 / $853.60
| Facility | | $372.10 | $482.99 | $853.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.06 / $702.10 / $1,145.33
| Professional | | $474.06 | $702.10 | $1,145.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.57 / $675.46 / $1,373.80
| Professional | | $404.57 | $675.46 | $1,373.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.75 / $678.50 / $6,679.00
| Facility | | $314.75 | $678.50 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.98 / $413.16 / $666.09
| Professional | | $223.98 | $413.16 | $666.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.58 / $806.93 / $1,131.03
| Professional | | $391.58 | $806.93 | $1,131.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,115.38 / $4,115.38 / $4,115.38
| Facility | | $4,115.38 | $4,115.38 | $4,115.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $4,249.00 / $26,542.00
| Facility | | $1,902.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.90 / $828.41 / $3,031.43
| Professional | | $405.90 | $828.41 | $3,031.43 |
- 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
- $396.80 / $530.36 / $1,123.20
| Professional | | $396.80 | $530.36 | $1,123.20 |