- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.91 / $5,412.00 / $10,767.00
| Facility | | $632.91 | $5,412.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.91 / $702.50 / $7,327.90
| Professional | | $632.91 | $702.50 | $7,327.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.96 / $832.19 / $1,172.42
| Professional | | $653.96 | $832.19 | $1,172.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.13 / $1,036.98 / $15,962.00
| Professional | | $768.13 | $1,036.98 | $15,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,657.31 / $11,588.77 / $14,292.82
| Professional | | $9,657.31 | $11,588.77 | $14,292.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.91 / $945.10 / $10,405.62
| Facility | | $632.91 | $945.10 | $10,405.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.36 / $9,743.00 / $16,684.90
| Professional | | $779.36 | $9,743.00 | $16,684.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.94 / $4,691.21 / $16,954.00
| Facility | | $755.94 | $4,691.21 | $16,954.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.94 / $4,691.21 / $16,954.00
| Professional | | $755.94 | $4,691.21 | $16,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,301.00 / $20,974.00 / $40,876.00
| Facility | | $12,301.00 | $20,974.00 | $40,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.60 / $696.48 / $1,571.43
| Professional | | $405.60 | $696.48 | $1,571.43 |