- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.54 / $2,663.12 / $4,410.00
| Facility | | $617.54 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.72 / $567.53 / $943.09
| Professional | | $467.72 | $567.53 | $943.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,227.78 / $3,445.00
| Facility | | $736.00 | $1,227.78 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.44 / $1,080.39 / $4,259.60
| Professional | | $473.44 | $1,080.39 | $4,259.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.40 / $757.38 / $1,352.08
| Facility | | $589.40 | $757.38 | $1,352.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.29 / $954.88 / $1,664.47
| Professional | | $524.29 | $954.88 | $1,664.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.55 / $1,074.72 / $6,679.00
| Facility | | $487.55 | $1,074.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.85 / $839.20 / $1,167.90
| Professional | | $687.85 | $839.20 | $1,167.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.87 / $1,238.55 / $1,612.49
| Professional | | $591.87 | $1,238.55 | $1,612.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $26,542.00
| Facility | | $627.00 | $2,217.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.22 / $1,243.18 / $4,259.60
| Professional | | $563.22 | $1,243.18 | $4,259.60 |
- 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
- $525.03 / $895.78 / $1,728.87
| Professional | | $525.03 | $895.78 | $1,728.87 |