- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.32 / $2,822.00 / $6,075.00
| Facility | | $420.32 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.98 / $420.32 / $614.76
| Professional | | $376.98 | $420.32 | $614.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $4,287.00 / $26,542.00
| Facility | | $941.10 | $4,287.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.57 / $801.98 / $3,345.14
| Professional | | $428.57 | $801.98 | $3,345.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.47 / $3,830.42 / $3,830.42
| Professional | | $1,472.47 | $3,830.42 | $3,830.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $1,947.00 / $6,019.56
| Facility | | $1,770.00 | $1,947.00 | $6,019.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.05 / $705.14 / $1,400.71
| Professional | | $405.05 | $705.14 | $1,400.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.05 / $843.24 / $6,679.00
| Facility | | $396.05 | $843.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.47 / $574.27 / $930.54
| Professional | | $454.47 | $574.27 | $930.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.98 / $975.12 / $1,230.31
| Professional | | $493.98 | $975.12 | $1,230.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $5,572.00 / $26,542.00
| Facility | | $1,485.00 | $5,572.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.83 / $801.98 / $3,345.14
| Professional | | $453.83 | $801.98 | $3,345.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $3,245.00 / $7,608.00
| Facility | | $1,485.00 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.60 / $629.35 / $1,447.21
| Professional | | $430.60 | $629.35 | $1,447.21 |