- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,685.00
| Facility | | $988.00 | $2,094.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.29 / $774.63 / $1,169.63
| Professional | | $677.29 | $774.63 | $1,169.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,868.50 / $3,445.00
| Facility | | $736.00 | $1,868.50 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.05 / $1,199.20 / $4,976.70
| Professional | | $746.05 | $1,199.20 | $4,976.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.55 / $1,406.97 / $1,905.96
| Professional | | $1,029.55 | $1,406.97 | $1,905.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.06 / $1,278.26 / $2,047.21
| Professional | | $810.06 | $1,278.26 | $2,047.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.93 / $1,564.40 / $6,679.00
| Facility | | $732.93 | $1,564.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.04 / $1,016.86 / $1,376.67
| Professional | | $841.04 | $1,016.86 | $1,376.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.06 / $1,748.41 / $2,301.46
| Professional | | $924.06 | $1,748.41 | $2,301.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,868.50 / $3,628.91
| Facility | | $627.00 | $1,868.50 | $3,628.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.76 / $1,200.17 / $5,344.32
| Professional | | $781.76 | $1,200.17 | $5,344.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.08 / $1,146.58 / $2,273.04
| Professional | | $770.08 | $1,146.58 | $2,273.04 |