- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.89 / $1,253.31 / $8,413.00
| Facility | | $779.89 | $1,253.31 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.44 / $817.48 / $1,456.79
| Professional | | $706.44 | $817.48 | $1,456.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.31 / $1,326.31 / $1,345.66
| Facility | | $1,326.31 | $1,326.31 | $1,345.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.11 / $1,008.55 / $2,050.78
| Professional | | $260.11 | $1,008.55 | $2,050.78 |
- 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
- $621.04 / $1,030.75 / $2,017.00
| Professional | | $621.04 | $1,030.75 | $2,017.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $869.74 / $1,518.51
| Facility | | $640.00 | $869.74 | $1,518.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $1,000.00 / $1,035.00
| Professional | | $579.00 | $1,000.00 | $1,035.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.30 / $1,214.57 / $1,329.50
| Professional | | $1,051.30 | $1,214.57 | $1,329.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.88 / $882.24 / $1,941.37
| Professional | | $594.88 | $882.24 | $1,941.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.28 / $8,957.00 / $26,542.00
| Facility | | $3,000.28 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,791.36 / $5,791.36 / $6,902.48
| Professional | | $5,791.36 | $5,791.36 | $6,902.48 |