- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.61 / $2,079.00 / $3,625.00
| Facility | | $400.61 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.99 / $413.96 / $742.51
| Professional | | $341.99 | $413.96 | $742.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.61 / $2,575.00 / $5,454.00
| Facility | | $764.61 | $2,575.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.73 / $584.07 / $2,483.44
| Professional | | $327.73 | $584.07 | $2,483.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.96 / $528.23 / $933.57
| Facility | | $406.96 | $528.23 | $933.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.60 / $741.00 / $1,141.36
| Professional | | $524.60 | $741.00 | $1,141.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.66 / $358.66 / $358.66
| Facility | | $358.66 | $358.66 | $358.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.37 / $684.35 / $1,261.65
| Professional | | $346.37 | $684.35 | $1,261.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.60 / $742.06 / $6,679.00
| Facility | | $341.60 | $742.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.51 / $609.80 / $841.77
| Professional | | $482.51 | $609.80 | $841.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.20 / $877.38 / $1,390.34
| Professional | | $418.20 | $877.38 | $1,390.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.98 / $678.78 / $3,144.32
| Professional | | $409.98 | $678.78 | $3,144.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.90 / $530.67 / $1,242.96
| Professional | | $379.90 | $530.67 | $1,242.96 |