- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.95 / $10,087.00 / $11,986.00
| Facility | | $658.95 | $10,087.00 | $11,986.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.84 / $694.18 / $1,397.37
| Professional | | $606.84 | $694.18 | $1,397.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.99 / $1,132.98 / $1,776.40
| Professional | | $775.99 | $1,132.98 | $1,776.40 |
- 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
- $740.83 / $946.44 / $1,682.04
| Professional | | $740.83 | $946.44 | $1,682.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.95 / $916.00 / $1,349.66
| Facility | | $658.95 | $916.00 | $1,349.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.64 / $829.00 / $876.00
| Professional | | $815.64 | $829.00 | $876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $891.80 / $1,776.00
| Professional | | $5.00 | $891.80 | $1,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $8,736.00 / $13,997.00
| Facility | | $2,629.00 | $8,736.00 | $13,997.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.64 / $810.10 / $1,760.12
| Professional | | $578.64 | $810.10 | $1,760.12 |
- 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
- $4,902.16 / $4,902.16 / $5,847.90
| Professional | | $4,902.16 | $4,902.16 | $5,847.90 |