- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.44 / $1,523.24 / $12,615.00
| Facility | | $629.44 | $1,523.24 | $12,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.44 / $666.13 / $1,222.80
| Professional | | $629.44 | $666.13 | $1,222.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,665.55 / $2,665.55 / $3,808.74
| Facility | | $2,665.55 | $2,665.55 | $3,808.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.60 / $1,019.13 / $1,691.83
| Professional | | $590.60 | $1,019.13 | $1,691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $16,000.13
| Facility | | $852.10 | $852.10 | $16,000.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.41 / $902.92 / $1,601.92
| Professional | | $705.41 | $902.92 | $1,601.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.44 / $776.66 / $1,285.15
| Facility | | $629.44 | $776.66 | $1,285.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.66 / $794.00 / $852.00
| Professional | | $776.66 | $794.00 | $852.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $852.30 / $1,692.30
| Professional | | $4.00 | $852.30 | $1,692.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.17 / $766.14 / $1,552.59
| Professional | | $536.17 | $766.14 | $1,552.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,031.20 / $46,153.35 / $52,877.55
| Facility | | $3,031.20 | $46,153.35 | $52,877.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,683.52 / $4,683.52 / $5,583.08
| Professional | | $4,683.52 | $4,683.52 | $5,583.08 |