- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.89 / $903.00 / $7,362.00
| Facility | | $558.89 | $903.00 | $7,362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.89 / $588.82 / $1,118.73
| Professional | | $558.89 | $588.82 | $1,118.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.61 / $1,457.61 / $1,478.88
| Facility | | $1,457.61 | $1,457.61 | $1,478.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.99 / $1,404.83 / $3,408.03
| Professional | | $574.99 | $1,404.83 | $3,408.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.75 / $395.75 / $2,243.78
| Facility | | $395.75 | $395.75 | $2,243.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.24 / $832.75 / $3,054.27
| Professional | | $516.24 | $832.75 | $3,054.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.89 / $751.58 / $2,813.90
| Facility | | $558.89 | $751.58 | $2,813.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $567.00 / $1,487.21
| Professional | | $378.00 | $567.00 | $1,487.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $745.50 / $1,762.80
| Professional | | $5.00 | $745.50 | $1,762.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,733.00 / $6,543.00
| Facility | | $900.00 | $3,733.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.60 / $1,011.28 / $2,945.26
| Professional | | $479.60 | $1,011.28 | $2,945.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,295.38 / $7,415.30 / $12,000.00
| Facility | | $3,295.38 | $7,415.30 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,693.94 / $14,693.94 / $14,693.94
| Professional | | $14,693.94 | $14,693.94 | $14,693.94 |