- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.25 / $2,410.00 / $3,469.00
| Facility | | $342.25 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.64 / $440.55 / $696.04
| Professional | | $322.64 | $440.55 | $696.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.75 / $2,557.14 / $9,592.04
| Facility | | $310.75 | $2,557.14 | $9,592.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.72 / $914.73 / $3,803.52
| Professional | | $413.72 | $914.73 | $3,803.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.62 / $577.76 / $1,030.53
| Facility | | $449.62 | $577.76 | $1,030.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.09 / $689.70 / $827.30
| Facility | | $657.09 | $689.70 | $827.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.62 / $752.30 / $1,491.16
| Professional | | $378.62 | $752.30 | $1,491.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $614.88 / $6,679.00
| Facility | | $300.00 | $614.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.20 / $799.07 / $1,141.94
| Professional | | $615.20 | $799.07 | $1,141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.74 / $1,014.26 / $1,447.08
| Professional | | $543.74 | $1,014.26 | $1,447.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,557.14 / $5,454.00
| Facility | | $55.00 | $2,557.14 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.37 / $1,244.03 / $3,803.52
| Professional | | $490.37 | $1,244.03 | $3,803.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.85 / $792.77 / $1,622.12
| Professional | | $452.85 | $792.77 | $1,622.12 |