- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.66 / $1,009.34 / $7,278.00
| Facility | | $599.66 | $1,009.34 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.66 / $627.29 / $985.74
| Professional | | $599.66 | $627.29 | $985.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,657.11 / $2,812.07
| Facility | | $1,506.47 | $1,657.11 | $2,812.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.16 / $1,098.80 / $1,722.30
| Professional | | $769.16 | $1,098.80 | $1,722.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.00 / $1,359.55 / $2,702.90
| Facility | | $498.00 | $1,359.55 | $2,702.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.28 / $940.07 / $1,582.27
| Professional | | $663.28 | $940.07 | $1,582.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.66 / $792.86 / $1,168.00
| Facility | | $599.66 | $792.86 | $1,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.00 / $568.00 / $1,107.11
| Professional | | $508.00 | $568.00 | $1,107.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.10 / $825.80 / $1,405.50
| Professional | | $690.10 | $825.80 | $1,405.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.33 / $736.26 / $1,628.27
| Professional | | $538.33 | $736.26 | $1,628.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,445.80 / $7,909.30 / $16,394.00
| Facility | | $3,445.80 | $7,909.30 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,506.80 / $4,506.80 / $5,239.88
| Professional | | $4,506.80 | $4,506.80 | $5,239.88 |