- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.62 / $2,067.00 / $3,625.00
| Facility | | $418.62 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.91 / $434.70 / $716.05
| Professional | | $368.91 | $434.70 | $716.05 |
- 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
- $421.87 / $883.59 / $3,489.20
| Professional | | $421.87 | $883.59 | $3,489.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.23 / $681.35 / $1,216.34
| Facility | | $530.23 | $681.35 | $1,216.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.81 / $744.82 / $1,328.10
| Professional | | $459.81 | $744.82 | $1,328.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.52 / $966.82 / $6,679.00
| Facility | | $442.52 | $966.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.35 / $683.49 / $943.48
| Professional | | $561.35 | $683.49 | $943.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.59 / $1,106.36 / $1,480.32
| Professional | | $545.59 | $1,106.36 | $1,480.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $12,000.00
| Facility | | $627.00 | $2,217.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.96 / $941.92 / $3,489.20
| Professional | | $500.96 | $941.92 | $3,489.20 |
- 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
- $477.10 / $738.55 / $1,469.41
| Professional | | $477.10 | $738.55 | $1,469.41 |