- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.13 / $2,663.12 / $3,625.00
| Facility | | $441.13 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.69 / $475.56 / $699.02
| Professional | | $393.69 | $475.56 | $699.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.08 / $2,854.00 / $9,039.00
| Facility | | $926.08 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.53 / $586.21 / $1,651.08
| Professional | | $333.53 | $586.21 | $1,651.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.77 / $599.38 / $1,059.30
| Facility | | $461.77 | $599.38 | $1,059.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,316.29
| Professional | | $605.88 | $605.88 | $1,316.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.20 / $749.68 / $1,370.87
| Professional | | $393.20 | $749.68 | $1,370.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.74 / $842.00 / $6,679.00
| Facility | | $388.74 | $842.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.78 / $607.36 / $838.39
| Professional | | $483.78 | $607.36 | $838.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.77 / $980.57 / $1,445.96
| Professional | | $476.77 | $980.57 | $1,445.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $16,394.00
| Facility | | $1,685.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.74 / $624.90 / $3,680.00
| Professional | | $428.74 | $624.90 | $3,680.00 |
- 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
- $427.22 / $563.53 / $1,352.85
| Professional | | $427.22 | $563.53 | $1,352.85 |