- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.67 / $2,747.00 / $5,374.05
| Facility | | $526.67 | $2,747.00 | $5,374.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.36 / $715.52 / $1,923.64
| Professional | | $508.36 | $715.52 | $1,923.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.70 / $1,129.04 / $2,713.00
| Facility | | $520.70 | $1,129.04 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.70 / $1,135.58 / $5,032.64
| Professional | | $520.70 | $1,135.58 | $5,032.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.82 / $727.08 / $1,297.99
| Facility | | $565.82 | $727.08 | $1,297.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.47 / $1,043.22 / $1,903.02
| Professional | | $633.47 | $1,043.22 | $1,903.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $773.78 / $8,090.00
| Facility | | $300.00 | $773.78 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.83 / $961.59 / $1,319.51
| Professional | | $793.83 | $961.59 | $1,319.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.52 / $1,306.86 / $1,882.57
| Professional | | $602.52 | $1,306.86 | $1,882.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,818.00 / $3,445.00
| Facility | | $55.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.44 / $1,498.06 / $5,032.64
| Professional | | $781.44 | $1,498.06 | $5,032.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.32 / $1,091.78 / $2,153.35
| Professional | | $724.32 | $1,091.78 | $2,153.35 |