- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.42 / $2,663.12 / $4,410.00
| Facility | | $416.42 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.41 / $422.95 / $654.69
| Professional | | $354.41 | $422.95 | $654.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.17 / $2,628.00 / $26,542.00
| Facility | | $935.17 | $2,628.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.95 / $835.06 / $3,056.96
| Professional | | $412.95 | $835.06 | $3,056.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $1,695.28 / $1,695.28
| Professional | | $692.82 | $1,695.28 | $1,695.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,111.82
| Facility | | $680.00 | $748.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.58 / $712.45 / $1,473.95
| Professional | | $409.58 | $712.45 | $1,473.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.89 / $910.22 / $6,679.00
| Facility | | $420.89 | $910.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.97 / $614.40 / $896.50
| Professional | | $482.97 | $614.40 | $896.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.19 / $1,026.85 / $1,360.35
| Professional | | $520.19 | $1,026.85 | $1,360.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.99 / $640.99 / $675.92
| Professional | | $640.99 | $640.99 | $675.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $4,249.00 / $26,542.00
| Facility | | $1,061.00 | $4,249.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.71 / $842.80 / $3,056.96
| Professional | | $445.71 | $842.80 | $3,056.96 |
- 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
- $417.30 / $614.99 / $1,360.35
| Professional | | $417.30 | $614.99 | $1,360.35 |