- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.26 / $2,884.12 / $8,442.00
| Facility | | $598.26 | $2,884.12 | $8,442.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.25 / $606.88 / $1,026.03
| Professional | | $579.25 | $606.88 | $1,026.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.10 / $2,192.40 / $3,720.44
| Facility | | $1,993.10 | $2,192.40 | $3,720.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.22 / $974.44 / $1,607.31
| Professional | | $657.22 | $974.44 | $1,607.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.27 / $1,960.83 / $3,266.42
| Facility | | $692.27 | $1,960.83 | $3,266.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.49 / $867.17 / $1,543.11
| Professional | | $611.49 | $867.17 | $1,543.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.26 / $728.46 / $1,078.88
| Facility | | $598.26 | $728.46 | $1,078.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.00 / $1,592.00 / $1,874.60
| Professional | | $778.00 | $1,592.00 | $1,874.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.05 / $914.38 / $1,171.70
| Professional | | $598.05 | $914.38 | $1,171.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,557.00 / $11,999.00
| Facility | | $902.00 | $1,557.00 | $11,999.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.01 / $686.41 / $1,479.56
| Professional | | $509.01 | $686.41 | $1,479.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,425.34 / $9,558.29 / $26,542.00
| Facility | | $3,425.34 | $9,558.29 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,724.88 / $4,724.88 / $5,285.03
| Professional | | $4,724.88 | $4,724.88 | $5,285.03 |