- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.80 / $2,663.12 / $4,410.00
| Facility | | $508.80 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.22 / $508.80 / $735.44
| Professional | | $359.22 | $508.80 | $735.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,181.71 / $3,445.00
| Facility | | $736.00 | $1,181.71 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.16 / $802.13 / $2,648.32
| Professional | | $404.16 | $802.13 | $2,648.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.34 / $569.84 / $1,005.55
| Facility | | $438.34 | $569.84 | $1,005.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.16 / $766.18 / $1,631.76
| Professional | | $475.16 | $766.18 | $1,631.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.70 / $799.26 / $6,679.00
| Facility | | $367.70 | $799.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.52 / $736.76 / $1,018.18
| Professional | | $581.52 | $736.76 | $1,018.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.25 / $961.65 / $1,425.31
| Professional | | $454.25 | $961.65 | $1,425.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,518.98 / $26,542.00
| Facility | | $627.00 | $2,518.98 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.65 / $1,002.53 / $3,750.56
| Professional | | $601.65 | $1,002.53 | $3,750.56 |
- 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
- $546.96 / $763.76 / $1,573.55
| Professional | | $546.96 | $763.76 | $1,573.55 |