- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.33 / $2,747.00 / $5,454.00
| Facility | | $384.33 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.33 / $585.73 / $1,417.56
| Professional | | $384.33 | $585.73 | $1,417.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.83 / $1,759.00 / $4,927.22
| Facility | | $521.83 | $1,759.00 | $4,927.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.93 / $948.62 / $3,317.36
| Professional | | $504.93 | $948.62 | $3,317.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.83 / $880.93 / $1,518.72
| Professional | | $639.83 | $880.93 | $1,518.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.44 / $955.75 / $1,732.32
| Professional | | $530.44 | $955.75 | $1,732.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $734.69 / $8,090.00
| Facility | | $300.00 | $734.69 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.62 / $528.08 / $851.37
| Professional | | $283.62 | $528.08 | $851.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.23 / $1,170.07 / $1,485.61
| Professional | | $590.23 | $1,170.07 | $1,485.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.86 / $775.86 / $775.86
| Professional | | $775.86 | $775.86 | $775.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $5,876.00
| Facility | | $55.00 | $2,854.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.23 / $1,005.58 / $3,317.36
| Professional | | $578.23 | $1,005.58 | $3,317.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.65 / $812.04 / $1,579.23
| Professional | | $546.65 | $812.04 | $1,579.23 |