- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.51 / $2,079.00 / $3,625.00
| Facility | | $227.51 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.11 / $227.51 / $574.98
| Professional | | $206.11 | $227.51 | $574.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $1,600.00 / $3,804.00
| Facility | | $789.00 | $1,600.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.00 / $862.37 / $1,894.64
| Professional | | $555.00 | $862.37 | $1,894.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.47 / $386.47 / $386.47
| Facility | | $386.47 | $386.47 | $386.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.82 / $540.82 / $540.82
| Professional | | $540.82 | $540.82 | $540.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.11 / $866.01 / $8,090.00
| Facility | | $548.11 | $866.01 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.26 / $800.77 / $1,084.11
| Professional | | $647.26 | $800.77 | $1,084.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.68 / $1,412.36 / $2,006.63
| Professional | | $805.68 | $1,412.36 | $2,006.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,078.00 / $7,161.00
| Facility | | $789.00 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.00 / $805.91 / $4,046.97
| Professional | | $513.00 | $805.91 | $4,046.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,078.00 / $5,683.00
| Facility | | $700.00 | $2,078.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.00 / $734.03 / $1,601.55
| Professional | | $513.00 | $734.03 | $1,601.55 |