- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.25 / $2,410.00 / $3,469.00
| Facility | | $340.25 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.61 / $433.41 / $671.12
| Professional | | $318.61 | $433.41 | $671.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,388.00 / $16,394.00
| Facility | | $822.00 | $2,388.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.44 / $896.80 / $3,815.44
| Professional | | $417.44 | $896.80 | $3,815.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.34 / $529.86 / $945.08
| Facility | | $412.34 | $529.86 | $945.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $1,620.25 / $1,620.25
| Professional | | $605.88 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,103.98
| Facility | | $593.00 | $652.29 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.69 / $728.50 / $1,475.20
| Professional | | $404.69 | $728.50 | $1,475.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.55 / $751.86 / $6,679.00
| Facility | | $347.55 | $751.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.26 / $790.80 / $1,136.48
| Professional | | $612.26 | $790.80 | $1,136.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.01 / $948.63 / $1,443.45
| Professional | | $507.01 | $948.63 | $1,443.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,388.00 / $16,394.00
| Facility | | $822.00 | $2,388.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.72 / $1,275.72 / $3,815.44
| Professional | | $537.72 | $1,275.72 | $3,815.44 |
- 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
- $496.65 / $767.44 / $1,625.23
| Professional | | $496.65 | $767.44 | $1,625.23 |