- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.21 / $2,079.00 / $3,625.00
| Facility | | $477.21 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.04 / $498.78 / $779.33
| Professional | | $430.04 | $498.78 | $779.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.01 / $1,184.64 / $3,445.00
| Facility | | $464.01 | $1,184.64 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.67 / $986.87 / $3,850.32
| Professional | | $504.67 | $986.87 | $3,850.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.72 / $771.93 / $1,378.05
| Facility | | $600.72 | $771.93 | $1,378.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.38 / $845.44 / $1,478.34
| Professional | | $534.38 | $845.44 | $1,478.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.47 / $1,095.35 / $6,679.00
| Facility | | $502.47 | $1,095.35 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $617.94 / $750.12 / $1,035.46
| Professional | | $617.94 | $750.12 | $1,035.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.95 / $1,230.97 / $1,595.50
| Professional | | $620.95 | $1,230.97 | $1,595.50 |
- 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
- $558.55 / $1,070.61 / $3,850.32
| Professional | | $558.55 | $1,070.61 | $3,850.32 |
- 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
- $543.76 / $823.66 / $1,588.07
| Professional | | $543.76 | $823.66 | $1,588.07 |