- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.03 / $4,032.00 / $8,920.00
| Facility | | $693.03 | $4,032.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.05 / $693.03 / $768.75
| Professional | | $494.05 | $693.03 | $768.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.45 / $707.74 / $1,005.09
| Professional | | $553.45 | $707.74 | $1,005.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.00 / $822.00 / $1,013.00
| Professional | | $642.00 | $822.00 | $1,013.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.71 / $1,001.71 / $1,001.71
| Facility | | $1,001.71 | $1,001.71 | $1,001.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.82 / $540.82 / $540.82
| Professional | | $540.82 | $540.82 | $540.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.36 / $801.60 / $1,002.00
| Professional | | $681.36 | $801.60 | $1,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.02 / $693.03 / $1,153.13
| Facility | | $504.02 | $693.03 | $1,153.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.00 / $1,094.94 / $1,546.30
| Professional | | $908.00 | $1,094.94 | $1,546.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.13 / $843.33 / $3,150.00
| Facility | | $548.13 | $843.33 | $3,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.32 / $843.33 / $3,150.00
| Professional | | $552.32 | $843.33 | $3,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,890.00 / $3,765.00
| Facility | | $1,066.00 | $1,890.00 | $3,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.75 / $554.66 / $960.85
| Professional | | $402.75 | $554.66 | $960.85 |