- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.07 / $2,663.12 / $3,625.00
| Facility | | $720.07 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.27 / $720.07 / $1,132.76
| Professional | | $496.27 | $720.07 | $1,132.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,376.00 / $4,870.64
| Facility | | $818.35 | $2,376.00 | $4,870.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.79 / $967.82 / $3,576.24
| Professional | | $536.79 | $967.82 | $3,576.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.08 / $755.40 / $1,333.00
| Facility | | $581.08 | $755.40 | $1,333.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.78 / $1,159.83 / $1,721.77
| Professional | | $820.78 | $1,159.83 | $1,721.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.49 / $567.49 / $567.49
| Facility | | $567.49 | $567.49 | $567.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.34 / $1,055.77 / $1,872.95
| Professional | | $554.34 | $1,055.77 | $1,872.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $794.64 / $8,090.00
| Facility | | $300.00 | $794.64 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.55 / $963.75 / $1,330.35
| Professional | | $762.55 | $963.75 | $1,330.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.88 / $1,303.31 / $2,132.15
| Professional | | $600.88 | $1,303.31 | $2,132.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,362.46 / $8,498.00
| Facility | | $55.00 | $3,362.46 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.17 / $1,108.96 / $4,969.60
| Professional | | $713.17 | $1,108.96 | $4,969.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.42 / $974.27 / $2,093.82
| Professional | | $694.42 | $974.27 | $2,093.82 |