- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.76 / $1,077.81 / $7,439.00
| Facility | | $712.76 | $1,077.81 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.76 / $748.37 / $1,399.06
| Professional | | $712.76 | $748.37 | $1,399.06 |
- 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
- $689.83 / $1,170.60 / $1,971.21
| Professional | | $689.83 | $1,170.60 | $1,971.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,587.44
| Facility | | $606.10 | $606.10 | $1,587.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.23 / $1,047.54 / $1,840.87
| Professional | | $809.23 | $1,047.54 | $1,840.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.76 / $924.83 / $1,492.20
| Facility | | $712.76 | $924.83 | $1,492.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.00 / $885.00 / $993.00
| Professional | | $885.00 | $885.00 | $993.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,008.00 / $2,018.80
| Professional | | $3.00 | $1,008.00 | $2,018.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $6,331.00 / $9,616.00
| Facility | | $1,711.00 | $6,331.00 | $9,616.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.07 / $951.66 / $1,998.00
| Professional | | $614.07 | $951.66 | $1,998.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,579.05 / $5,246.20
| Facility | | $55.00 | $4,579.05 | $5,246.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,573.28 / $5,573.28 / $6,583.35
| Professional | | $5,573.28 | $5,573.28 | $6,583.35 |