- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.75 / $2,618.00 / $3,625.00
| Facility | | $360.75 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.67 / $372.28 / $544.74
| Professional | | $309.67 | $372.28 | $544.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.95 / $2,628.00 / $16,394.00
| Facility | | $884.95 | $2,628.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.18 / $732.38 / $4,015.48
| Professional | | $370.18 | $732.38 | $4,015.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $1,695.28 / $1,695.28
| Professional | | $605.88 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $3,111.82
| Facility | | $593.00 | $652.29 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.39 / $616.29 / $1,309.92
| Professional | | $375.39 | $616.29 | $1,309.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.53 / $809.84 / $6,679.00
| Facility | | $374.53 | $809.84 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.77 / $546.64 / $797.75
| Professional | | $429.77 | $546.64 | $797.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.99 / $925.79 / $1,168.07
| Professional | | $468.99 | $925.79 | $1,168.07 |
- 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
- $388.68 / $732.38 / $4,015.48
| Professional | | $388.68 | $732.38 | $4,015.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $8,766.00
| Facility | | $1,061.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.21 / $543.79 / $1,226.46
| Professional | | $378.21 | $543.79 | $1,226.46 |