- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.45 / $2,618.00 / $3,625.00
| Facility | | $309.45 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.67 / $309.45 / $395.06
| Professional | | $273.67 | $309.45 | $395.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.05 / $1,704.90 / $5,047.31
| Facility | | $362.05 | $1,704.90 | $5,047.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.83 / $562.04 / $2,185.92
| Professional | | $306.83 | $562.04 | $2,185.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.35 / $1,620.25 / $1,620.25
| Professional | | $448.35 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $1,463.30
| Facility | | $680.00 | $748.00 | $1,463.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.44 / $512.13 / $962.29
| Professional | | $306.44 | $512.13 | $962.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.37 / $412.37 / $485.14
| Professional | | $412.37 | $412.37 | $485.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.88 / $747.91 / $965.77
| Professional | | $378.88 | $747.91 | $965.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,329.00 / $4,755.00
| Facility | | $55.00 | $2,329.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.80 / $571.95 / $2,185.92
| Professional | | $328.80 | $571.95 | $2,185.92 |
- 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
- $316.51 / $458.56 / $988.56
| Professional | | $316.51 | $458.56 | $988.56 |