- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.37 / $2,618.00 / $3,625.00
| Facility | | $277.37 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.81 / $277.37 / $565.47
| Professional | | $161.81 | $277.37 | $565.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.88 / $1,052.09 / $3,445.00
| Facility | | $503.88 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.81 / $525.14 / $1,558.56
| Professional | | $234.81 | $525.14 | $1,558.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.92 / $328.80 / $598.01
| Facility | | $252.92 | $328.80 | $598.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.55 / $550.28 / $962.70
| Professional | | $329.55 | $550.28 | $962.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.08 / $507.58 / $1,119.63
| Professional | | $267.08 | $507.58 | $1,119.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.36 / $461.18 / $6,679.00
| Facility | | $218.36 | $461.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.66 / $538.03 / $743.83
| Professional | | $424.66 | $538.03 | $743.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.83 / $565.13 / $1,038.81
| Professional | | $265.83 | $565.13 | $1,038.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.23 / $700.19 / $2,741.92
| Professional | | $339.23 | $700.19 | $2,741.92 |
- 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
- $275.16 / $521.26 / $1,050.29
| Professional | | $275.16 | $521.26 | $1,050.29 |