- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.33 / $2,079.00 / $3,625.00
| Facility | | $336.33 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.64 / $336.33 / $730.82
| Professional | | $247.64 | $336.33 | $730.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.79 / $941.10 / $2,733.00
| Facility | | $335.79 | $941.10 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.79 / $736.84 / $2,779.44
| Professional | | $325.79 | $736.84 | $2,779.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.78 / $452.11 / $797.81
| Facility | | $347.78 | $452.11 | $797.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.79 / $744.61 / $1,213.49
| Professional | | $367.79 | $744.61 | $1,213.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.06 / $475.61 / $8,090.00
| Facility | | $297.06 | $475.61 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.70 / $446.81 / $720.35
| Professional | | $241.70 | $446.81 | $720.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.11 / $798.36 / $1,087.58
| Professional | | $382.11 | $798.36 | $1,087.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,139.44 / $2,139.44 / $2,139.44
| Professional | | $2,139.44 | $2,139.44 | $2,139.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,856.00 / $3,445.00
| Facility | | $55.00 | $1,856.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.23 / $1,046.78 / $2,779.44
| Professional | | $503.23 | $1,046.78 | $2,779.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.04 / $596.27 / $1,155.82
| Professional | | $464.04 | $596.27 | $1,155.82 |