- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.64 / $2,079.00 / $3,625.00
| Facility | | $533.64 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.20 / $574.90 / $845.35
| Professional | | $486.20 | $574.90 | $845.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.89 / $1,267.00 / $3,472.00
| Facility | | $541.89 | $1,267.00 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.69 / $734.00 / $3,488.56
| Professional | | $401.69 | $734.00 | $3,488.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.91 / $739.76 / $1,307.40
| Facility | | $569.91 | $739.76 | $1,307.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.47 / $386.47 / $386.47
| Facility | | $386.47 | $386.47 | $386.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.28 / $924.34 / $1,671.78
| Professional | | $461.28 | $924.34 | $1,671.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.13 / $1,039.18 / $6,679.00
| Facility | | $479.13 | $1,039.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.91 / $732.09 / $1,010.57
| Professional | | $582.91 | $732.09 | $1,010.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.37 / $1,166.02 / $1,536.03
| Professional | | $587.37 | $1,166.02 | $1,536.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,161.00
| Facility | | $55.00 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.27 / $819.89 / $3,824.96
| Professional | | $517.27 | $819.89 | $3,824.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,078.00 / $5,683.00
| Facility | | $700.00 | $2,078.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.58 / $678.53 / $1,580.37
| Professional | | $514.58 | $678.53 | $1,580.37 |