- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.56 / $2,618.00 / $3,625.00
| Facility | | $773.56 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.49 / $773.56 / $1,149.89
| Professional | | $688.49 | $773.56 | $1,149.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,411.51 / $16,394.00
| Facility | | $818.35 | $2,411.51 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.48 / $1,472.39 / $5,458.40
| Professional | | $734.48 | $1,472.39 | $5,458.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $928.83 / $928.83
| Professional | | $605.88 | $928.83 | $928.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $652.29 / $1,463.30
| Facility | | $593.00 | $652.29 | $1,463.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.47 / $1,240.67 / $2,414.48
| Professional | | $555.47 | $1,240.67 | $2,414.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,658.64 / $6,679.00
| Facility | | $506.00 | $1,658.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.45 / $1,119.58 / $1,699.20
| Professional | | $871.45 | $1,119.58 | $1,699.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.84 / $1,839.45 / $2,345.44
| Professional | | $931.84 | $1,839.45 | $2,345.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $4,170.06 / $16,394.00
| Facility | | $822.00 | $4,170.06 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.35 / $1,492.43 / $5,458.40
| Professional | | $808.35 | $1,492.43 | $5,458.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.91 / $1,171.18 / $2,639.88
| Professional | | $756.91 | $1,171.18 | $2,639.88 |