- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.70 / $1,181.00 / $7,439.00
| Facility | | $732.70 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.70 / $771.61 / $1,369.52
| Professional | | $732.70 | $771.61 | $1,369.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.37 / $1,493.61 / $2,018.07
| Professional | | $884.37 | $1,493.61 | $2,018.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $6,025.59
| Facility | | $530.04 | $530.04 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.97 / $1,077.73 / $1,875.49
| Professional | | $840.97 | $1,077.73 | $1,875.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.70 / $1,031.19 / $1,608.35
| Facility | | $732.70 | $1,031.19 | $1,608.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $930.00 / $974.00
| Professional | | $507.00 | $930.00 | $974.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $990.70 / $1,981.20
| Professional | | $4.00 | $990.70 | $1,981.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.11 / $899.63 / $1,955.80
| Professional | | $646.11 | $899.63 | $1,955.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,528.30 / $17,381.18 / $19,913.50
| Facility | | $3,528.30 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,212.07 / $6,212.07 / $6,497.93
| Professional | | $6,212.07 | $6,212.07 | $6,497.93 |