- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.68 / $2,618.00 / $3,625.00
| Facility | | $655.68 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.11 / $668.21 / $995.67
| Professional | | $572.11 | $668.21 | $995.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.00 / $3,669.06 / $13,773.00
| Facility | | $322.00 | $3,669.06 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.06 / $1,238.44 / $4,801.92
| Professional | | $682.06 | $1,238.44 | $4,801.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $8,230.78
| Facility | | $680.00 | $748.00 | $8,230.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.04 / $1,093.51 / $2,122.25
| Professional | | $521.04 | $1,093.51 | $2,122.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,096.43 / $6,679.00
| Facility | | $300.00 | $1,096.43 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.38 / $986.78 / $1,424.42
| Professional | | $767.38 | $986.78 | $1,424.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.02 / $1,618.72 / $2,090.23
| Professional | | $820.02 | $1,618.72 | $2,090.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,728.00 / $16,742.00
| Facility | | $55.00 | $3,728.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.50 / $1,292.04 / $4,801.92
| Professional | | $722.50 | $1,292.04 | $4,801.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $12,850.00
| Facility | | $1,591.00 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.03 / $1,031.09 / $2,865.74
| Professional | | $704.03 | $1,031.09 | $2,865.74 |