- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.29 / $2,618.00 / $3,625.00
| Facility | | $367.29 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.64 / $378.34 / $542.78
| Professional | | $342.64 | $378.34 | $542.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.42 / $2,813.24 / $16,394.00
| Facility | | $820.42 | $2,813.24 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.87 / $699.97 / $2,826.69
| Professional | | $377.87 | $699.97 | $2,826.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $2,406.48 / $2,406.48
| Professional | | $605.88 | $2,406.48 | $2,406.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $1,923.56
| Facility | | $593.00 | $652.29 | $1,923.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.12 / $626.33 / $1,223.50
| Professional | | $392.12 | $626.33 | $1,223.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.88 / $735.92 / $6,679.00
| Facility | | $345.88 | $735.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.90 / $501.53 / $889.62
| Professional | | $396.90 | $501.53 | $889.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.72 / $852.22 / $1,075.24
| Professional | | $431.72 | $852.22 | $1,075.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $16,394.00
| Facility | | $1,061.00 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.46 / $707.80 / $2,826.69
| Professional | | $406.46 | $707.80 | $2,826.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.76 / $601.80 / $1,205.28
| Professional | | $401.76 | $601.80 | $1,205.28 |