- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.21 / $7,439.00 / $8,646.95
| Facility | | $606.21 | $7,439.00 | $8,646.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.22 / $587.96 / $1,161.77
| Professional | | $552.22 | $587.96 | $1,161.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.79 / $600.79 / $600.79
| Professional | | $600.79 | $600.79 | $600.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.09 / $989.91 / $1,646.79
| Professional | | $708.09 | $989.91 | $1,646.79 |
- 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
- $634.10 / $864.61 / $1,472.01
| Professional | | $634.10 | $864.61 | $1,472.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.90 / $789.62 / $1,255.63
| Facility | | $561.90 | $789.62 | $1,255.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $723.00 / $759.50
| Professional | | $579.00 | $723.00 | $759.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $855.80 / $1,551.90
| Professional | | $3.00 | $855.80 | $1,551.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.45 / $720.64 / $1,419.48
| Professional | | $510.45 | $720.64 | $1,419.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.96 / $8,957.00 / $26,542.00
| Facility | | $2,122.96 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,544.78 / $4,544.78 / $4,787.47
| Professional | | $4,544.78 | $4,544.78 | $4,787.47 |