- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.32 / $2,663.12 / $3,625.00
| Facility | | $379.32 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.98 / $379.32 / $617.92
| Professional | | $259.98 | $379.32 | $617.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.46 / $1,069.15 / $3,445.00
| Facility | | $679.46 | $1,069.15 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.79 / $861.63 / $2,773.28
| Professional | | $421.79 | $861.63 | $2,773.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.66 / $591.05 / $1,042.99
| Facility | | $454.66 | $591.05 | $1,042.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.30 / $852.14 / $1,730.55
| Professional | | $471.30 | $852.14 | $1,730.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.54 / $829.02 / $6,679.00
| Facility | | $383.54 | $829.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.49 / $811.86 / $1,120.68
| Professional | | $641.49 | $811.86 | $1,120.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.77 / $980.57 / $1,571.12
| Professional | | $476.77 | $980.57 | $1,571.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,637.48 / $16,394.00
| Facility | | $627.00 | $2,637.48 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.16 / $1,050.99 / $4,142.80
| Professional | | $567.16 | $1,050.99 | $4,142.80 |
- 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
- $473.37 / $802.28 / $2,003.31
| Professional | | $473.37 | $802.28 | $2,003.31 |