- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.27 / $2,663.12 / $3,625.00
| Facility | | $652.27 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.12 / $652.27 / $1,025.80
| Professional | | $480.12 | $652.27 | $1,025.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $3,253.20 / $9,039.00
| Facility | | $1,070.00 | $3,253.20 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.26 / $896.24 / $3,453.68
| Professional | | $494.26 | $896.24 | $3,453.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.79 / $734.23 / $1,295.63
| Facility | | $564.79 | $734.23 | $1,295.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.88 / $605.88 / $1,392.16
| Professional | | $605.88 | $605.88 | $1,392.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.76 / $992.61 / $1,808.24
| Professional | | $546.76 | $992.61 | $1,808.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.60 / $1,029.83 / $6,679.00
| Facility | | $474.60 | $1,029.83 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $704.18 / $890.52 / $1,229.27
| Professional | | $704.18 | $890.52 | $1,229.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.63 / $1,235.44 / $2,028.74
| Professional | | $581.63 | $1,235.44 | $2,028.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,764.00 / $16,394.00
| Facility | | $1,685.00 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.37 / $1,003.09 / $4,584.56
| Professional | | $650.37 | $1,003.09 | $4,584.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.46 / $844.54 / $1,929.81
| Professional | | $611.46 | $844.54 | $1,929.81 |