- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.99 / $1,245.00 / $8,413.00
| Facility | | $611.99 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.91 / $642.05 / $1,143.82
| Professional | | $533.91 | $642.05 | $1,143.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.92 / $4,397.92 / $6,284.08
| Facility | | $4,397.92 | $4,397.92 | $6,284.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.57 / $1,049.41 / $1,652.31
| Professional | | $711.57 | $1,049.41 | $1,652.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $3,435.20
| Facility | | $606.10 | $606.10 | $3,435.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.96 / $886.25 / $1,560.20
| Professional | | $673.96 | $886.25 | $1,560.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.99 / $849.00 / $1,227.85
| Facility | | $611.99 | $849.00 | $1,227.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $774.00 / $814.00
| Professional | | $579.00 | $774.00 | $814.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.20 / $953.54 / $1,043.77
| Professional | | $829.20 | $953.54 | $1,043.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.17 / $792.44 / $1,685.63
| Professional | | $539.17 | $792.44 | $1,685.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.48 / $11,352.75 / $26,542.00
| Facility | | $2,355.48 | $11,352.75 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,551.04 / $4,551.04 / $5,424.98
| Professional | | $4,551.04 | $4,551.04 | $5,424.98 |