- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.92 / $846.14 / $10,561.00
| Facility | | $510.92 | $846.14 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.92 / $527.97 / $1,039.55
| Professional | | $510.92 | $527.97 | $1,039.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.34 / $1,920.34 / $1,948.36
| Facility | | $1,920.34 | $1,920.34 | $1,948.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.41 / $920.45 / $1,431.53
| Professional | | $611.41 | $920.45 | $1,431.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $5,006.99
| Facility | | $606.10 | $606.10 | $5,006.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.74 / $735.32 / $1,314.98
| Professional | | $563.74 | $735.32 | $1,314.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.92 / $652.85 / $1,149.00
| Facility | | $510.92 | $652.85 | $1,149.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.85 / $674.00 / $681.00
| Professional | | $652.85 | $674.00 | $681.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $690.70 / $1,435.00
| Professional | | $5.00 | $690.70 | $1,435.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.53 / $634.02 / $1,239.19
| Professional | | $438.53 | $634.02 | $1,239.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $14,442.95 / $16,547.20
| Facility | | $2,000.00 | $14,442.95 | $16,547.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,864.16 / $4,864.16 / $4,864.16
| Professional | | $4,864.16 | $4,864.16 | $4,864.16 |