- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.37 / $2,663.12 / $3,625.00
| Facility | | $451.37 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $463.22 / $772.64
| Professional | | $407.74 | $463.22 | $772.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,384.73 / $7,161.00
| Facility | | $818.35 | $2,384.73 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.24 / $929.26 / $3,678.80
| Professional | | $456.24 | $929.26 | $3,678.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.65 / $717.87 / $1,281.54
| Facility | | $558.65 | $717.87 | $1,281.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.26 / $806.76 / $1,395.80
| Professional | | $484.26 | $806.76 | $1,395.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.97 / $1,018.64 / $6,679.00
| Facility | | $465.97 | $1,018.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.20 / $721.46 / $995.90
| Professional | | $592.20 | $721.46 | $995.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.26 / $1,166.67 / $1,556.68
| Professional | | $574.26 | $1,166.67 | $1,556.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,384.73 / $16,394.00
| Facility | | $1,106.00 | $2,384.73 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.34 / $996.76 / $3,678.80
| Professional | | $526.34 | $996.76 | $3,678.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.79 / $760.73 / $1,541.52
| Professional | | $506.79 | $760.73 | $1,541.52 |