- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.14 / $2,079.00 / $3,625.00
| Facility | | $633.14 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.97 / $451.57 / $1,083.99
| Professional | | $118.97 | $451.57 | $1,083.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.95 / $941.10 / $2,796.00
| Facility | | $183.95 | $941.10 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.30 / $1,002.95 / $2,556.82
| Professional | | $176.30 | $1,002.95 | $2,556.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.15 / $247.20 / $484.88
| Facility | | $190.15 | $247.20 | $484.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.82 / $786.95 / $2,117.64
| Professional | | $258.82 | $786.95 | $2,117.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.60 / $260.04 / $6,679.00
| Facility | | $167.60 | $260.04 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.66 / $851.32 / $1,522.11
| Professional | | $718.66 | $851.32 | $1,522.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.49 / $606.14 / $1,579.54
| Professional | | $208.49 | $606.14 | $1,579.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,086.28 / $3,445.00
| Facility | | $55.00 | $1,086.28 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.97 / $1,600.80 / $4,153.20
| Professional | | $919.97 | $1,600.80 | $4,153.20 |
- 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
- $868.62 / $1,393.56 / $2,556.82
| Professional | | $868.62 | $1,393.56 | $2,556.82 |