- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.39 / $2,618.00 / $3,625.00
| Facility | | $433.39 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.93 / $439.29 / $661.45
| Professional | | $382.93 | $439.29 | $661.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.91 / $4,397.14 / $15,421.00
| Facility | | $972.91 | $4,397.14 | $15,421.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.21 / $849.84 / $5,296.80
| Professional | | $445.21 | $849.84 | $5,296.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $3,178.05 / $3,178.05
| Professional | | $452.37 | $3,178.05 | $3,178.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $6,699.12
| Facility | | $443.00 | $500.00 | $6,699.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.31 / $730.98 / $1,448.99
| Professional | | $456.31 | $730.98 | $1,448.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.00 / $863.70 / $6,679.00
| Facility | | $377.00 | $863.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.99 / $586.30 / $919.72
| Professional | | $463.99 | $586.30 | $919.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.36 / $1,007.45 / $1,271.09
| Professional | | $510.36 | $1,007.45 | $1,271.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $6,883.00 / $17,070.15
| Facility | | $1,697.00 | $6,883.00 | $17,070.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.58 / $849.84 / $5,296.80
| Professional | | $485.58 | $849.84 | $5,296.80 |
- 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
- $451.84 / $666.91 / $1,467.09
| Professional | | $451.84 | $666.91 | $1,467.09 |