- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.47 / $2,079.00 / $3,625.00
| Facility | | $735.47 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.62 / $800.20 / $1,163.58
| Professional | | $635.62 | $800.20 | $1,163.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,997.00 / $9,039.00
| Facility | | $1,313.00 | $3,997.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.19 / $1,053.08 / $4,556.39
| Professional | | $565.19 | $1,053.08 | $4,556.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.22 / $964.70 / $1,704.95
| Facility | | $743.22 | $964.70 | $1,704.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $452.37 / $1,392.16
| Professional | | $452.37 | $452.37 | $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
- $642.25 / $1,242.46 / $2,308.34
| Professional | | $642.25 | $1,242.46 | $2,308.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.17 / $1,349.66 / $6,679.00
| Facility | | $625.17 | $1,349.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.66 / $1,019.92 / $1,407.89
| Professional | | $810.66 | $1,019.92 | $1,407.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.36 / $1,581.09 / $2,381.04
| Professional | | $766.36 | $1,581.09 | $2,381.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $12,000.00
| Facility | | $1,685.00 | $4,525.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.00 / $1,268.95 / $5,690.45
| Professional | | $737.00 | $1,268.95 | $5,690.45 |
- 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
- $721.87 / $1,101.17 / $2,279.84
| Professional | | $721.87 | $1,101.17 | $2,279.84 |