- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.10 / $356.48 / $644.77
| Professional | | $315.10 | $356.48 | $644.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.60 / $1,287.88 / $3,250.27
| Facility | | $420.60 | $1,287.88 | $3,250.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.68 / $630.90 / $2,677.04
| Professional | | $343.68 | $630.90 | $2,677.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.75 / $747.70 / $1,012.87
| Professional | | $483.75 | $747.70 | $1,012.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.24 / $593.85 / $1,055.70
| Professional | | $370.24 | $593.85 | $1,055.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.97 / $831.36 / $6,679.00
| Facility | | $376.97 | $831.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.57 / $527.76 / $731.60
| Professional | | $432.57 | $527.76 | $731.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.98 / $908.00 / $1,181.97
| Professional | | $459.98 | $908.00 | $1,181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,371.04 / $4,142.00
| Facility | | $55.00 | $1,371.04 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.32 / $634.37 / $2,677.04
| Professional | | $353.32 | $634.37 | $2,677.04 |
- 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
- $347.22 / $557.07 / $1,114.58
| Professional | | $347.22 | $557.07 | $1,114.58 |