- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.25 / $6,461.00 / $14,482.00
| Facility | | $656.25 | $6,461.00 | $14,482.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.41 / $656.25 / $682.76
| Professional | | $516.41 | $656.25 | $682.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,060.00 / $7,344.00 / $10,517.23
| Facility | | $5,060.00 | $7,344.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.39 / $214.24 / $304.22
| Professional | | $171.39 | $214.24 | $304.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.54 / $1,730.13 / $2,654.06
| Facility | | $1,480.54 | $1,730.13 | $2,654.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.50 / $1,182.74 / $3,844.78
| Professional | | $902.50 | $1,182.74 | $3,844.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.25 / $656.25 / $2,837.84
| Facility | | $656.25 | $656.25 | $2,837.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.25 / $7,251.10 / $12,631.00
| Facility | | $656.25 | $7,251.10 | $12,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,365.79 / $3,365.79 / $3,365.79
| Professional | | $3,365.79 | $3,365.79 | $3,365.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $8,407.99
| Professional | | $50.00 | $70.00 | $8,407.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.25 / $656.25 / $2,837.84
| Facility | | $656.25 | $656.25 | $2,837.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,365.79 / $3,365.79 / $3,365.79
| Professional | | $3,365.79 | $3,365.79 | $3,365.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,181.08 / $1,181.08 / $1,181.08
| Professional | | $1,181.08 | $1,181.08 | $1,181.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,073.00 / $9,837.00 / $12,062.00
| Facility | | $6,073.00 | $9,837.00 | $12,062.00 |