- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.00 / $1,245.00 / $8,413.00
| Facility | | $683.00 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.00 / $719.38 / $1,276.40
| Professional | | $683.00 | $719.38 | $1,276.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.30 / $1,311.30 / $1,330.43
| Facility | | $1,311.30 | $1,311.30 | $1,330.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.84 / $795.01 / $1,807.82
| Professional | | $504.84 | $795.01 | $1,807.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.27 / $891.74 / $1,771.90
| Professional | | $490.27 | $891.74 | $1,771.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $766.67 / $1,239.78
| Facility | | $627.00 | $766.67 | $1,239.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $882.00 / $905.00
| Professional | | $579.00 | $882.00 | $905.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $916.90 / $1,832.50
| Professional | | $5.00 | $916.90 | $1,832.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.53 / $726.22 / $1,711.00
| Professional | | $467.53 | $726.22 | $1,711.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,915.00 / $6,817.20 / $26,542.00
| Facility | | $3,915.00 | $6,817.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,081.04 / $5,081.04 / $5,977.58
| Professional | | $5,081.04 | $5,081.04 | $5,977.58 |