- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.21 / $2,079.00 / $3,625.00
| Facility | | $467.21 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.35 / $338.38 / $628.66
| Professional | | $140.35 | $338.38 | $628.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $586.26 / $586.26 / $586.26
| Facility | 52 | $586.26 | $586.26 | $586.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.31 / $805.49 / $3,102.00
| Professional | | $478.31 | $805.49 | $3,102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.07 / $220.17 / $437.08
| Facility | | $171.07 | $220.17 | $437.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.57 / $397.85 / $985.34
| Professional | | $200.57 | $397.85 | $985.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.74 / $233.94 / $6,679.00
| Facility | | $148.74 | $233.94 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.97 / $542.88 / $754.92
| Professional | | $444.97 | $542.88 | $754.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.69 / $469.40 / $1,127.97
| Professional | | $198.69 | $469.40 | $1,127.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,628.00 / $9,039.00
| Facility | | $55.00 | $2,628.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $586.26 / $586.26 / $586.26
| Facility | 52 | $586.26 | $586.26 | $586.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.52 / $803.04 / $3,102.00
| Professional | | $466.52 | $803.04 | $3,102.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.83 / $669.75 / $1,213.52
| Professional | | $461.83 | $669.75 | $1,213.52 |