- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.84 / $1,245.00 / $8,413.00
| Facility | | $556.84 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.79 / $587.26 / $1,043.73
| Professional | | $512.79 | $587.26 | $1,043.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.82 / $1,109.82 / $1,585.80
| Facility | | $1,109.82 | $1,109.82 | $1,585.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.64 / $949.78 / $1,494.85
| Professional | | $634.64 | $949.78 | $1,494.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.05 / $806.47 / $1,407.54
| Professional | | $602.05 | $806.47 | $1,407.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.84 / $674.38 / $1,232.00
| Facility | | $556.84 | $674.38 | $1,232.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $693.00 / $743.00
| Professional | | $579.00 | $693.00 | $743.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $757.20 / $1,489.00
| Professional | | $3.00 | $757.20 | $1,489.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.00 / $3,456.00 / $6,097.00
| Facility | | $1,064.00 | $3,456.00 | $6,097.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.75 / $667.97 / $1,368.93
| Professional | | $472.75 | $667.97 | $1,368.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.88 / $8,957.00 / $26,542.00
| Facility | | $2,146.88 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,944.00 / $5,121.38 / $5,121.38
| Professional | | $4,944.00 | $5,121.38 | $5,121.38 |