- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.05 / $2,185.00 / $4,553.00
| Facility | | $367.05 | $2,185.00 | $4,553.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.11 / $412.18 / $1,025.60
| Professional | | $264.11 | $412.18 | $1,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.28 / $1,052.09 / $3,445.00
| Facility | | $605.28 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.63 / $618.48 / $1,874.40
| Professional | | $280.63 | $618.48 | $1,874.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.87 / $392.43 / $692.49
| Facility | | $301.87 | $392.43 | $692.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.39 / $665.04 / $1,059.93
| Professional | | $434.39 | $665.04 | $1,059.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.83 / $652.13 / $1,329.32
| Professional | | $323.83 | $652.13 | $1,329.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.20 / $550.41 / $6,679.00
| Facility | | $261.20 | $550.41 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.17 / $593.28 / $818.96
| Professional | | $469.17 | $593.28 | $818.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.44 / $666.08 / $1,148.58
| Professional | | $317.44 | $666.08 | $1,148.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.95 / $698.56 / $1,928.58
| Facility | | $259.95 | $698.56 | $1,928.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.80 / $668.62 / $798.23
| Professional | | $342.80 | $668.62 | $798.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $26,542.00
| Facility | | $627.00 | $1,818.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.66 / $805.33 / $3,045.84
| Professional | | $414.66 | $805.33 | $3,045.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.12 / $456.74 / $903.59
| Professional | | $363.12 | $456.74 | $903.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.81 / $600.90 / $1,159.32
| Professional | | $353.81 | $600.90 | $1,159.32 |