- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.42 / $2,067.00 / $3,625.00
| Facility | | $376.42 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.67 / $394.61 / $659.25
| Professional | | $350.67 | $394.61 | $659.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.40 / $1,856.00 / $4,142.00
| Facility | | $660.40 | $1,856.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.12 / $779.45 / $3,075.44
| Professional | | $389.12 | $779.45 | $3,075.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.00 / $610.38 / $1,089.65
| Facility | | $475.00 | $610.38 | $1,089.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.16 / $677.38 / $1,170.44
| Professional | | $418.16 | $677.38 | $1,170.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.73 / $866.10 / $6,679.00
| Facility | | $396.73 | $866.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.23 / $601.01 / $829.63
| Professional | | $494.23 | $601.01 | $829.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.47 / $985.79 / $1,320.07
| Professional | | $489.47 | $985.79 | $1,320.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $12,000.00
| Facility | | $627.00 | $2,217.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.46 / $830.86 / $3,075.44
| Professional | | $435.46 | $830.86 | $3,075.44 |
- 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
- $413.94 / $635.22 / $1,271.26
| Professional | | $413.94 | $635.22 | $1,271.26 |