- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.47 / $1,181.00 / $7,439.00
| Facility | | $820.47 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.70 / $863.40 / $1,530.85
| Professional | | $775.70 | $863.40 | $1,530.85 |
- 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
- $583.85 / $1,053.76 / $1,804.54
| Professional | | $583.85 | $1,053.76 | $1,804.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $1,587.44
| Facility | | $530.04 | $530.04 | $1,587.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.85 / $1,051.97 / $1,942.13
| Professional | | $689.85 | $1,051.97 | $1,942.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $835.09 / $1,394.80
| Facility | | $718.00 | $835.09 | $1,394.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $805.00 / $1,090.00
| Professional | | $507.00 | $805.00 | $1,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $1,123.40 / $1,413.60
| Professional | | $10.00 | $1,123.40 | $1,413.60 |
- 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
- $626.26 / $870.45 / $1,991.71
| Professional | | $626.26 | $870.45 | $1,991.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,920.89 / $10,653.06 / $16,394.00
| Facility | | $8,920.89 | $10,653.06 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,511.95 / $6,511.95 / $7,653.38
| Professional | | $6,511.95 | $6,511.95 | $7,653.38 |