- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.22 / $2,079.00 / $3,625.00
| Facility | | $422.22 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.89 / $446.31 / $643.54
| Professional | | $378.89 | $446.31 | $643.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,502.30 / $12,000.00
| Facility | | $822.00 | $2,502.30 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.88 / $882.72 / $3,277.04
| Professional | | $446.88 | $882.72 | $3,277.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $1,620.25 / $1,620.25
| Professional | | $452.37 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,103.98
| Facility | | $443.00 | $500.00 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.83 / $739.27 / $1,459.11
| Professional | | $385.83 | $739.27 | $1,459.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.00 / $1,014.16 / $6,679.00
| Facility | | $377.00 | $1,014.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.00 / $684.56 / $1,010.32
| Professional | | $528.00 | $684.56 | $1,010.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.33 / $1,106.08 / $1,428.28
| Professional | | $560.33 | $1,106.08 | $1,428.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,649.00 / $12,000.00
| Facility | | $822.00 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.66 / $882.72 / $3,277.04
| Professional | | $466.66 | $882.72 | $3,277.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.01 / $685.48 / $1,577.25
| Professional | | $447.01 | $685.48 | $1,577.25 |