- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.98 / $1,823.00 / $3,363.00
| Facility | | $293.98 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.50 / $378.07 / $596.97
| Professional | | $290.50 | $378.07 | $596.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.70 / $2,157.96 / $5,454.00
| Facility | | $276.70 | $2,157.96 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.25 / $807.09 / $3,355.36
| Professional | | $367.25 | $807.09 | $3,355.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.71 / $485.36 / $865.71
| Facility | | $377.71 | $485.36 | $865.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.30 / $680.00 / $748.00
| Facility | | $571.30 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.70 / $660.13 / $1,296.11
| Professional | | $335.70 | $660.13 | $1,296.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $482.10 / $6,679.00
| Facility | | $168.26 | $482.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.27 / $703.76 / $1,006.57
| Professional | | $542.27 | $703.76 | $1,006.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.16 / $859.10 / $1,276.53
| Professional | | $459.16 | $859.10 | $1,276.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,157.96 / $5,454.00
| Facility | | $55.00 | $2,157.96 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.24 / $1,115.33 / $3,355.36
| Professional | | $442.24 | $1,115.33 | $3,355.36 |
- 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
- $395.98 / $661.28 / $1,425.86
| Professional | | $395.98 | $661.28 | $1,425.86 |