- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.81 / $2,618.00 / $3,625.00
| Facility | | $499.81 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.11 / $532.10 / $867.01
| Professional | | $455.11 | $532.10 | $867.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,856.00 / $4,142.00
| Facility | | $736.00 | $1,856.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.84 / $1,027.74 / $4,030.80
| Professional | | $515.84 | $1,027.74 | $4,030.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.04 / $787.77 / $1,406.34
| Facility | | $613.04 | $787.77 | $1,406.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.99 / $885.51 / $1,549.95
| Professional | | $532.99 | $885.51 | $1,549.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.01 / $1,117.83 / $6,679.00
| Facility | | $513.01 | $1,117.83 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.97 / $785.68 / $1,084.55
| Professional | | $646.97 | $785.68 | $1,084.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.05 / $1,283.07 / $1,722.91
| Professional | | $634.05 | $1,283.07 | $1,722.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.91 / $574.91 / $574.91
| Professional | | $574.91 | $574.91 | $574.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $16,394.00
| Facility | | $627.00 | $2,217.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.46 / $1,108.16 / $4,030.80
| Professional | | $585.46 | $1,108.16 | $4,030.80 |
- 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
- $557.58 / $819.05 / $1,664.65
| Professional | | $557.58 | $819.05 | $1,664.65 |