- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.98 / $1,245.00 / $8,413.00
| Facility | | $672.98 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.98 / $707.81 / $1,453.64
| Professional | | $672.98 | $707.81 | $1,453.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,629.68 / $5,629.68 / $5,711.83
| Facility | | $5,629.68 | $5,629.68 | $5,711.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.92 / $1,198.51 / $1,856.16
| Professional | | $636.92 | $1,198.51 | $1,856.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.26 / $1,085.43 / $1,717.63
| Professional | | $764.26 | $1,085.43 | $1,717.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.98 / $935.71 / $1,520.93
| Facility | | $672.98 | $935.71 | $1,520.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.00 / $848.00 / $894.00
| Professional | | $848.00 | $848.00 | $894.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $909.60 / $1,845.30
| Professional | | $3.00 | $909.60 | $1,845.30 |
- 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
- $603.41 / $905.77 / $1,663.47
| Professional | | $603.41 | $905.77 | $1,663.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,670.11 / $17,132.00
| Facility | | $55.00 | $14,670.11 | $17,132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,538.69 / $5,538.69 / $5,961.83
| Professional | | $5,538.69 | $5,538.69 | $5,961.83 |