- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.50 / $2,618.00 / $3,625.00
| Facility | | $374.50 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.95 / $414.35 / $878.24
| Professional | | $336.95 | $414.35 | $878.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $1,024.14 / $3,445.00
| Facility | | $464.01 | $1,024.14 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.32 / $762.46 / $3,360.88
| Professional | | $401.32 | $762.46 | $3,360.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.60 / $647.13 / $1,155.26
| Facility | | $503.60 | $647.13 | $1,155.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.32 / $863.42 / $1,249.94
| Professional | | $604.32 | $863.42 | $1,249.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.92 / $697.74 / $1,205.41
| Professional | | $432.92 | $697.74 | $1,205.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.40 / $918.26 / $6,679.00
| Facility | | $421.40 | $918.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.88 / $655.99 / $905.52
| Professional | | $539.88 | $655.99 | $905.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.01 / $1,053.50 / $1,362.49
| Professional | | $521.01 | $1,053.50 | $1,362.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.72 / $402.72 / $402.72
| Professional | | $402.72 | $402.72 | $402.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,146.94 / $16,394.00
| Facility | | $627.00 | $2,146.94 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.32 / $861.97 / $3,360.88
| Professional | | $442.32 | $861.97 | $3,360.88 |
- 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
- $429.52 / $654.36 / $1,387.25
| Professional | | $429.52 | $654.36 | $1,387.25 |