- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.83 / $2,663.12 / $3,625.00
| Facility | | $437.83 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.19 / $469.53 / $709.99
| Professional | | $341.19 | $469.53 | $709.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,209.69 / $3,445.00
| Facility | | $736.00 | $1,209.69 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.79 / $904.27 / $3,329.92
| Professional | | $448.79 | $904.27 | $3,329.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.27 / $716.65 / $1,264.60
| Facility | | $551.27 | $716.65 | $1,264.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.66 / $844.99 / $1,769.10
| Professional | | $502.66 | $844.99 | $1,769.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.43 / $1,005.20 / $6,679.00
| Facility | | $462.43 | $1,005.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.67 / $823.96 / $1,137.38
| Professional | | $651.67 | $823.96 | $1,137.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.39 / $1,175.18 / $1,602.22
| Professional | | $571.39 | $1,175.18 | $1,602.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,353.19 / $16,394.00
| Facility | | $627.00 | $2,353.19 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.64 / $1,064.22 / $4,215.04
| Professional | | $536.64 | $1,064.22 | $4,215.04 |
- 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
- $448.79 / $818.96 / $1,692.87
| Professional | | $448.79 | $818.96 | $1,692.87 |