- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.57 / $2,079.00 / $3,625.00
| Facility | | $428.57 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.08 / $467.43 / $971.80
| Professional | | $274.08 | $467.43 | $971.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.10 / $2,826.85 / $9,039.00
| Facility | | $941.10 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.03 / $991.26 / $4,412.64
| Professional | | $453.03 | $991.26 | $4,412.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.17 / $627.29 / $1,119.85
| Facility | | $488.17 | $627.29 | $1,119.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.22 / $865.30 / $1,624.78
| Professional | | $435.22 | $865.30 | $1,624.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $890.12 / $6,679.00
| Facility | | $408.71 | $890.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.56 / $870.58 / $1,206.50
| Professional | | $713.56 | $870.58 | $1,206.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.72 / $1,115.53 / $1,777.60
| Professional | | $530.72 | $1,115.53 | $1,777.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.98 / $1,859.98 / $1,859.98
| Facility | | $1,859.98 | $1,859.98 | $1,859.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $12,000.00
| Facility | | $1,902.00 | $3,764.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.35 / $1,277.59 / $4,412.64
| Professional | | $545.35 | $1,277.59 | $4,412.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.74 / $872.68 / $1,801.70
| Professional | | $510.74 | $872.68 | $1,801.70 |