- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.00 / $2,547.00 / $3,693.00
| Facility | | $699.00 | $2,547.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.71 / $499.70 / $1,351.98
| Professional | | $362.71 | $499.70 | $1,351.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.62 / $2,575.00 / $9,592.04
| Facility | | $602.62 | $2,575.00 | $9,592.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.75 / $822.26 / $3,356.56
| Professional | | $401.75 | $822.26 | $3,356.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.63 / $559.78 / $999.34
| Facility | | $435.63 | $559.78 | $999.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.00 / $738.74 / $1,351.44
| Professional | | $453.00 | $738.74 | $1,351.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.93 / $794.32 / $6,679.00
| Facility | | $366.93 | $794.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.08 / $648.07 / $894.59
| Professional | | $534.08 | $648.07 | $894.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.66 / $971.16 / $1,325.61
| Professional | | $462.66 | $971.16 | $1,325.61 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $510.97 / $1,016.58 / $3,356.56
| Professional | | $510.97 | $1,016.58 | $3,356.56 |
- 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
- $484.07 / $717.78 / $1,404.60
| Professional | | $484.07 | $717.78 | $1,404.60 |