- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.11 / $2,663.12 / $3,625.00
| Facility | | $444.11 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.23 / $497.67 / $1,007.79
| Professional | | $280.23 | $497.67 | $1,007.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.54 / $1,039.19 / $3,445.00
| Facility | | $355.54 | $1,039.19 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.60 / $916.59 / $3,025.68
| Professional | | $458.60 | $916.59 | $3,025.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.43 / $642.76 / $1,134.22
| Facility | | $494.43 | $642.76 | $1,134.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.52 / $940.27 / $1,827.67
| Professional | | $512.52 | $940.27 | $1,827.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.81 / $901.54 / $6,679.00
| Facility | | $417.81 | $901.54 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.60 / $842.79 / $1,163.38
| Professional | | $667.60 | $842.79 | $1,163.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.19 / $1,069.86 / $1,638.92
| Professional | | $520.19 | $1,069.86 | $1,638.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,707.00 / $16,394.00
| Facility | | $627.00 | $2,707.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.54 / $1,095.57 / $4,321.20
| Professional | | $600.54 | $1,095.57 | $4,321.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.36 / $846.08 / $1,641.89
| Professional | | $486.36 | $846.08 | $1,641.89 |