- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.34 / $1,001.89 / $7,362.00
| Facility | | $675.34 | $1,001.89 | $7,362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.34 / $711.06 / $1,266.46
| Professional | | $675.34 | $711.06 | $1,266.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.89 / $115.89 / $117.58
| Facility | | $115.89 | $115.89 | $117.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.72 / $1,320.21 / $1,817.07
| Professional | | $775.72 | $1,320.21 | $1,817.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $1,438.74
| Facility | | $395.75 | $395.75 | $1,438.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.72 / $966.51 / $1,719.57
| Professional | | $729.72 | $966.51 | $1,719.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.34 / $886.77 / $1,350.45
| Facility | | $675.34 | $886.77 | $1,350.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $798.00 / $904.00
| Professional | | $378.00 | $798.00 | $904.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $920.50 / $1,816.00
| Professional | | $4.00 | $920.50 | $1,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.00 / $896.00 / $2,229.00
| Facility | | $117.00 | $896.00 | $2,229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.79 / $810.52 / $1,666.37
| Professional | | $589.79 | $810.52 | $1,666.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,270.30 / $4,754.80 / $12,000.00
| Facility | | $3,270.30 | $4,754.80 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,052.24 / $5,052.24 / $6,026.33
| Professional | | $5,052.24 | $5,052.24 | $6,026.33 |