- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.33 / $2,083.00 / $3,625.00
| Facility | | $321.33 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.39 / $326.98 / $488.92
| Professional | | $278.39 | $326.98 | $488.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.96 / $1,599.82 / $5,564.75
| Facility | | $696.96 | $1,599.82 | $5,564.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.12 / $637.48 / $2,392.88
| Professional | | $341.12 | $637.48 | $2,392.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.79 / $1,124.79 / $1,124.79
| Professional | | $1,124.79 | $1,124.79 | $1,124.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $2,183.86
| Facility | | $443.00 | $500.00 | $2,183.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.75 / $550.97 / $1,166.88
| Professional | | $278.75 | $550.97 | $1,166.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $543.02 / $6,679.00
| Facility | | $300.00 | $543.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.32 / $488.71 / $711.53
| Professional | | $383.32 | $488.71 | $711.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.38 / $823.91 / $1,039.53
| Professional | | $417.38 | $823.91 | $1,039.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $1,866.13 / $5,564.75
| Facility | | $822.00 | $1,866.13 | $5,564.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.74 / $648.41 / $2,392.88
| Professional | | $343.74 | $648.41 | $2,392.88 |
- 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
- $341.12 / $480.42 / $1,038.76
| Professional | | $341.12 | $480.42 | $1,038.76 |