- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.09 / $3,107.00 / $7,625.00
| Facility | | $744.09 | $3,107.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.81 / $777.57 / $1,158.80
| Professional | | $684.81 | $777.57 | $1,158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,553.10 / $10,160.00
| Facility | | $789.00 | $2,553.10 | $10,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.79 / $1,476.16 / $5,500.88
| Professional | | $804.79 | $1,476.16 | $5,500.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.41 / $1,277.08 / $2,687.47
| Professional | | $694.41 | $1,277.08 | $2,687.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $1,631.88 / $6,679.00
| Facility | | $714.00 | $1,631.88 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.88 / $1,104.25 / $1,622.10
| Professional | | $873.88 | $1,104.25 | $1,622.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.97 / $1,885.11 / $2,328.67
| Professional | | $962.97 | $1,885.11 | $2,328.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,466.00 / $10,160.00
| Facility | | $822.00 | $3,466.00 | $10,160.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.50 / $1,530.12 / $5,500.88
| Professional | | $838.50 | $1,530.12 | $5,500.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.35 / $1,214.58 / $2,452.39
| Professional | | $816.35 | $1,214.58 | $2,452.39 |