- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.88 / $2,663.12 / $3,693.00
| Facility | | $355.88 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.90 / $355.88 / $710.98
| Professional | | $217.90 | $355.88 | $710.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.05 / $3,372.00 / $10,821.00
| Facility | | $651.05 | $3,372.00 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.72 / $708.00 / $2,914.00
| Professional | | $281.72 | $708.00 | $2,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.52 / $403.68 / $712.33
| Facility | | $310.52 | $403.68 | $712.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.22 / $509.22 / $816.36
| Professional | | $509.22 | $509.22 | $816.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.86 / $736.00 / $1,196.05
| Professional | | $382.86 | $736.00 | $1,196.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.31 / $566.20 / $6,679.00
| Facility | | $264.31 | $566.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.03 / $595.20 / $1,023.32
| Professional | | $471.03 | $595.20 | $1,023.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.80 / $701.75 / $1,106.68
| Professional | | $325.80 | $701.75 | $1,106.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.68 / $763.68 / $763.68
| Professional | | $763.68 | $763.68 | $763.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,649.00 / $16,394.00
| Facility | | $1,640.00 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.48 / $1,115.10 / $2,914.00
| Professional | | $400.48 | $1,115.10 | $2,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.49 / $659.14 / $1,426.74
| Professional | | $339.49 | $659.14 | $1,426.74 |