- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.73 / $2,663.12 / $4,410.00
| Facility | | $361.73 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.91 / $361.73 / $534.44
| Professional | | $324.91 | $361.73 | $534.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.56 / $3,245.00 / $26,542.00
| Facility | | $771.56 | $3,245.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.13 / $647.79 / $2,532.25
| Professional | | $340.13 | $647.79 | $2,532.25 |
- 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 / $4,755.37
| Facility | | $680.00 | $748.00 | $4,755.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.20 / $569.96 / $1,117.41
| Professional | | $342.20 | $569.96 | $1,117.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.79 / $665.34 / $6,679.00
| Facility | | $317.79 | $665.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.66 / $460.80 / $823.87
| Professional | | $364.66 | $460.80 | $823.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.41 / $792.38 / $999.75
| Professional | | $401.41 | $792.38 | $999.75 |
- 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
- $367.91 / $684.20 / $2,532.25
| Professional | | $367.91 | $684.20 | $2,532.25 |
- 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
- $359.99 / $582.46 / $1,297.08
| Professional | | $359.99 | $582.46 | $1,297.08 |