- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.58 / $2,079.00 / $3,625.00
| Facility | | $514.58 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.73 / $539.05 / $871.15
| Professional | | $467.73 | $539.05 | $871.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,856.00 / $4,142.00
| Facility | | $736.00 | $1,856.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.66 / $1,056.33 / $4,144.47
| Professional | | $532.66 | $1,056.33 | $4,144.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.87 / $808.10 / $1,442.63
| Facility | | $628.87 | $808.10 | $1,442.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.42 / $910.13 / $1,593.78
| Professional | | $547.42 | $910.13 | $1,593.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.50 / $1,146.68 / $6,679.00
| Facility | | $526.50 | $1,146.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.19 / $807.53 / $1,114.71
| Professional | | $665.19 | $807.53 | $1,114.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.26 / $1,318.27 / $1,765.60
| Professional | | $651.26 | $1,318.27 | $1,765.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,217.00 / $12,000.00
| Facility | | $627.00 | $2,217.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.13 / $1,152.56 / $4,144.47
| Professional | | $602.13 | $1,152.56 | $4,144.47 |
- 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
- $573.46 / $864.27 / $1,966.06
| Professional | | $573.46 | $864.27 | $1,966.06 |