- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.80 / $2,663.12 / $3,625.00
| Facility | | $465.80 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.33 / $507.53 / $804.08
| Professional | | $446.33 | $507.53 | $804.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $1,201.39 / $3,445.00
| Facility | | $464.01 | $1,201.39 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.33 / $993.46 / $3,981.42
| Professional | | $489.33 | $993.46 | $3,981.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.04 / $776.19 / $1,385.67
| Facility | | $604.04 | $776.19 | $1,385.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.07 / $848.71 / $1,456.61
| Professional | | $522.07 | $848.71 | $1,456.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.77 / $1,101.40 / $6,679.00
| Facility | | $507.77 | $1,101.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.54 / $715.34 / $982.87
| Professional | | $590.54 | $715.34 | $982.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.37 / $1,197.32 / $1,590.42
| Professional | | $630.37 | $1,197.32 | $1,590.42 |
- 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
- $561.50 / $1,094.25 / $3,981.42
| Professional | | $561.50 | $1,094.25 | $3,981.42 |
- 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
- $525.83 / $804.35 / $1,652.04
| Professional | | $525.83 | $804.35 | $1,652.04 |