- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.00 / $2,079.00 / $3,625.00
| Facility | | $446.00 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.68 / $465.47 / $767.01
| Professional | | $409.68 | $465.47 | $767.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $1,103.21 / $3,445.00
| Facility | | $464.01 | $1,103.21 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.58 / $917.58 / $3,596.00
| Professional | | $462.58 | $917.58 | $3,596.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.69 / $717.92 / $1,281.63
| Facility | | $558.69 | $717.92 | $1,281.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.23 / $944.02 / $1,340.19
| Professional | | $667.23 | $944.02 | $1,340.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.43 / $790.36 / $1,376.86
| Professional | | $477.43 | $790.36 | $1,376.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.98 / $1,018.70 / $6,679.00
| Facility | | $466.98 | $1,018.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.20 / $701.26 / $968.02
| Professional | | $577.20 | $701.26 | $968.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.30 / $1,142.48 / $1,488.23
| Professional | | $576.30 | $1,142.48 | $1,488.23 |
- 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
- $523.82 / $1,018.14 / $3,596.00
| Professional | | $523.82 | $1,018.14 | $3,596.00 |
- 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
- $514.36 / $771.16 / $1,542.48
| Professional | | $514.36 | $771.16 | $1,542.48 |