- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.85 / $2,067.00 / $3,685.00
| Facility | | $397.85 | $2,067.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.38 / $430.97 / $737.62
| Professional | | $366.38 | $430.97 | $737.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,142.73 / $7,161.00
| Facility | | $818.35 | $2,142.73 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.13 / $827.89 / $3,267.84
| Professional | | $415.13 | $827.89 | $3,267.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $645.07 / $1,151.58
| Facility | | $502.00 | $645.07 | $1,151.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.21 / $844.37 / $1,192.91
| Professional | | $555.21 | $844.37 | $1,192.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.92 / $718.32 / $1,247.43
| Professional | | $443.92 | $718.32 | $1,247.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.64 / $915.34 / $6,679.00
| Facility | | $419.64 | $915.34 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.46 / $637.33 / $879.77
| Professional | | $524.46 | $637.33 | $879.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.73 / $1,047.98 / $1,400.66
| Professional | | $517.73 | $1,047.98 | $1,400.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.35 / $628.35 / $628.35
| Professional | | $628.35 | $628.35 | $628.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,142.73 / $12,000.00
| Facility | | $1,106.00 | $2,142.73 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.02 / $913.62 / $3,267.84
| Professional | | $471.02 | $913.62 | $3,267.84 |
- 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
- $463.99 / $703.26 / $1,899.34
| Professional | | $463.99 | $703.26 | $1,899.34 |