- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.62 / $2,618.00 / $3,625.00
| Facility | | $355.62 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.59 / $421.40 / $584.92
| Professional | | $351.59 | $421.40 | $584.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,266.23 / $16,394.00
| Facility | | $669.00 | $2,266.23 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.73 / $807.42 / $3,035.76
| Professional | | $412.73 | $807.42 | $3,035.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $711.49 / $711.49
| Professional | | $605.88 | $711.49 | $711.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $1,408.94
| Facility | | $593.00 | $652.29 | $1,408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.24 / $695.54 / $1,483.71
| Professional | | $416.24 | $695.54 | $1,483.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.91 / $913.98 / $6,679.00
| Facility | | $422.91 | $913.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.29 / $616.94 / $900.80
| Professional | | $485.29 | $616.94 | $900.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.02 / $1,046.26 / $1,320.07
| Professional | | $530.02 | $1,046.26 | $1,320.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,590.15 / $16,394.00
| Facility | | $822.00 | $3,590.15 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.49 / $825.96 / $3,035.76
| Professional | | $439.49 | $825.96 | $3,035.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,133.00 / $8,425.00
| Facility | | $822.00 | $3,133.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.51 / $597.90 / $1,372.80
| Professional | | $428.51 | $597.90 | $1,372.80 |