- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.64 / $2,083.00 / $3,625.00
| Facility | | $456.64 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.42 / $491.61 / $690.61
| Professional | | $434.42 | $491.61 | $690.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.00 / $2,628.00 / $11,217.00
| Facility | | $432.00 | $2,628.00 | $11,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.65 / $906.73 / $4,468.60
| Professional | | $501.65 | $906.73 | $4,468.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,212.69 / $3,212.69 / $3,212.69
| Professional | | $3,212.69 | $3,212.69 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $1,433.00 / $6,493.89
| Facility | | $680.00 | $1,433.00 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.02 / $781.71 / $1,516.52
| Professional | | $435.02 | $781.71 | $1,516.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.95 / $1,045.06 / $6,679.00
| Facility | | $489.95 | $1,045.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.22 / $710.43 / $1,043.58
| Professional | | $562.22 | $710.43 | $1,043.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.03 / $1,198.28 / $1,533.50
| Professional | | $607.03 | $1,198.28 | $1,533.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,717.34 / $12,379.00
| Facility | | $55.00 | $2,717.34 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.37 / $946.52 / $4,468.60
| Professional | | $527.37 | $946.52 | $4,468.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.65 / $742.78 / $1,579.72
| Professional | | $501.65 | $742.78 | $1,579.72 |