- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.66 / $2,663.12 / $4,410.00
| Facility | | $304.66 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.17 / $304.66 / $450.41
| Professional | | $273.17 | $304.66 | $450.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.00 / $4,671.00 / $26,542.00
| Facility | | $705.00 | $4,671.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.99 / $548.42 / $2,141.50
| Professional | | $285.99 | $548.42 | $2,141.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.82 / $2,140.21 / $2,140.21
| Professional | | $692.82 | $2,140.21 | $2,140.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $7,058.84
| Facility | | $680.00 | $748.00 | $7,058.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.95 / $491.87 / $943.66
| Professional | | $307.95 | $491.87 | $943.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.04 / $578.00 / $6,679.00
| Facility | | $273.04 | $578.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.17 / $388.15 / $693.99
| Professional | | $307.17 | $388.15 | $693.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.33 / $667.86 / $842.64
| Professional | | $338.33 | $667.86 | $842.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.59 / $6,883.00 / $26,542.00
| Facility | | $1,270.59 | $6,883.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.49 / $580.27 / $2,141.50
| Professional | | $309.49 | $580.27 | $2,141.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,097.00 / $14,018.00
| Facility | | $1,697.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.91 / $489.79 / $992.04
| Professional | | $305.91 | $489.79 | $992.04 |