- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.00 / $2,594.00 / $7,542.00
| Facility | | $662.00 | $2,594.00 | $7,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.00 / $528.15 / $855.68
| Professional | | $451.00 | $528.15 | $855.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.17 / $638.04 / $928.54
| Professional | | $476.17 | $638.04 | $928.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.97 / $508.97 / $508.97
| Facility | | $508.97 | $508.97 | $508.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.61 / $730.41 / $1,104.10
| Professional | | $550.61 | $730.41 | $1,104.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $3,258.85
| Facility | | $55.00 | $55.00 | $3,258.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,056.64 / $4,177.20 / $5,070.97
| Professional | | $4,056.64 | $4,177.20 | $5,070.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.04 / $729.30 / $1,186.21
| Facility | | $552.04 | $729.30 | $1,186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.45 / $868.55 / $1,021.82
| Professional | | $624.45 | $868.55 | $1,021.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.80 / $823.80 / $823.80
| Professional | | $823.80 | $823.80 | $823.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.66 / $736.12 / $1,271.16
| Facility | | $553.66 | $736.12 | $1,271.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.61 / $759.62 / $1,167.30
| Professional | | $550.61 | $759.62 | $1,167.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.85 / $619.21 / $1,009.86
| Professional | | $452.85 | $619.21 | $1,009.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.50 / $552.04 / $757.35
| Professional | | $484.50 | $552.04 | $757.35 |