- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.28 / $2,079.00 / $3,625.00
| Facility | | $363.28 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.16 / $373.15 / $612.74
| Professional | | $316.16 | $373.15 | $612.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $947.00 / $3,445.00
| Facility | | $464.01 | $947.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.81 / $750.35 / $2,986.24
| Professional | | $363.81 | $750.35 | $2,986.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.21 / $588.79 / $1,051.13
| Facility | | $458.21 | $588.79 | $1,051.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.10 / $651.13 / $1,126.68
| Professional | | $392.10 | $651.13 | $1,126.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.82 / $835.50 / $6,679.00
| Facility | | $381.82 | $835.50 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.07 / $586.44 / $809.51
| Professional | | $481.07 | $586.44 | $809.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.22 / $945.10 / $1,211.94
| Professional | | $470.22 | $945.10 | $1,211.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,170.50 / $12,000.00
| Facility | | $627.00 | $2,170.50 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.56 / $798.92 / $2,986.24
| Professional | | $404.56 | $798.92 | $2,986.24 |
- 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
- $396.20 / $573.76 / $1,179.78
| Professional | | $396.20 | $573.76 | $1,179.78 |