- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.82 / $1,381.56 / $8,413.00
| Facility | | $898.82 | $1,381.56 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.82 / $945.51 / $1,746.27
| Professional | | $898.82 | $945.51 | $1,746.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,855.05 / $6,855.05 / $6,955.07
| Facility | | $6,855.05 | $6,855.05 | $6,955.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.77 / $1,601.01 / $2,482.27
| Professional | | $1,009.77 | $1,601.01 | $2,482.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $11,384.53
| Facility | | $606.10 | $606.10 | $11,384.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.82 / $1,440.81 / $2,295.50
| Professional | | $1,027.82 | $1,440.81 | $2,295.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.82 / $1,347.00 / $2,031.33
| Facility | | $898.82 | $1,347.00 | $2,031.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $1,139.00 / $1,188.00
| Professional | | $579.00 | $1,139.00 | $1,188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,432.60 / $2,457.10
| Professional | | $3.00 | $1,432.60 | $2,457.10 |
- 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
- $809.56 / $1,202.33 / $2,225.94
| Professional | | $809.56 | $1,202.33 | $2,225.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.64 / $32,839.36 / $37,623.85
| Facility | | $3,445.64 | $32,839.36 | $37,623.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,408.96 / $7,408.96 / $7,926.38
| Professional | | $7,408.96 | $7,408.96 | $7,926.38 |