- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.41 / $9,120.65 / $12,615.00
| Facility | | $719.41 | $9,120.65 | $12,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.41 / $765.95 / $1,723.04
| Professional | | $719.41 | $765.95 | $1,723.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,948.57 / $5,948.57 / $8,499.76
| Facility | | $5,948.57 | $5,948.57 | $8,499.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.64 / $1,298.32 / $1,939.77
| Professional | | $840.64 | $1,298.32 | $1,939.77 |
- 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
- $805.49 / $1,036.36 / $1,840.23
| Professional | | $805.49 | $1,036.36 | $1,840.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.41 / $980.00 / $1,493.94
| Facility | | $719.41 | $980.00 | $1,493.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.93 / $912.00 / $955.00
| Professional | | $892.93 | $912.00 | $955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $970.70 / $1,937.60
| Professional | | $4.00 | $970.70 | $1,937.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.39 / $888.19 / $1,918.79
| Professional | | $631.39 | $888.19 | $1,918.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $22,387.71 / $26,144.65
| Facility | | $55.00 | $22,387.71 | $26,144.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,320.43 / $6,320.43 / $6,370.20
| Professional | | $6,320.43 | $6,320.43 | $6,370.20 |