- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.27 / $1,181.00 / $7,439.00
| Facility | | $683.27 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.27 / $722.52 / $1,378.73
| Professional | | $683.27 | $722.52 | $1,378.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.08 / $367.08 / $367.08
| Professional | | $367.08 | $367.08 | $367.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.87 / $2,226.87 / $2,259.36
| Facility | | $2,226.87 | $2,226.87 | $2,259.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.67 / $1,102.28 / $1,666.87
| Professional | | $600.67 | $1,102.28 | $1,666.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.57 / $964.05 / $1,721.00
| Professional | | $738.57 | $964.05 | $1,721.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.27 / $879.03 / $1,346.21
| Facility | | $683.27 | $879.03 | $1,346.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.77 / $861.00 / $909.00
| Professional | | $830.77 | $861.00 | $909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $925.90 / $1,827.60
| Professional | | $3.00 | $925.90 | $1,827.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.22 / $868.98 / $1,824.88
| Professional | | $582.22 | $868.98 | $1,824.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,817.95 / $8,957.00
| Facility | | $55.00 | $7,817.95 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,087.68 / $5,087.68 / $6,063.15
| Professional | | $5,087.68 | $5,087.68 | $6,063.15 |