- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.82 / $2,079.00 / $3,685.00
| Facility | | $529.82 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.14 / $560.86 / $923.33
| Professional | | $500.14 | $560.86 | $923.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,910.50 / $4,142.00
| Facility | | $736.00 | $1,910.50 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.80 / $1,097.61 / $4,286.16
| Professional | | $562.80 | $1,097.61 | $4,286.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.67 / $864.38 / $1,543.10
| Facility | | $672.67 | $864.38 | $1,543.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.58 / $938.58 / $1,651.60
| Professional | | $582.58 | $938.58 | $1,651.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.38 / $1,226.54 / $6,679.00
| Facility | | $563.38 | $1,226.54 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.04 / $832.77 / $1,149.54
| Professional | | $687.04 | $832.77 | $1,149.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.14 / $1,389.94 / $1,841.38
| Professional | | $697.14 | $1,389.94 | $1,841.38 |
- 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
- $624.50 / $1,191.27 / $4,286.16
| Professional | | $624.50 | $1,191.27 | $4,286.16 |
- 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
- $594.76 / $893.88 / $2,317.46
| Professional | | $594.76 | $893.88 | $2,317.46 |