- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.60 / $1,245.00 / $10,561.00
| Facility | | $658.60 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.60 / $705.26 / $1,351.68
| Professional | | $658.60 | $705.26 | $1,351.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.34 / $1,920.34 / $1,948.36
| Facility | | $1,920.34 | $1,920.34 | $1,948.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.00 / $1,189.91 / $1,853.93
| Professional | | $801.00 | $1,189.91 | $1,853.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $5,006.99
| Facility | | $748.70 | $748.70 | $5,006.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.72 / $990.37 / $1,765.09
| Professional | | $695.72 | $990.37 | $1,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $829.18 / $1,488.44
| Facility | | $603.00 | $829.18 | $1,488.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.00 / $937.00 / $937.00
| Professional | | $716.00 | $937.00 | $937.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $889.30 / $2,094.19
| Professional | | $5.00 | $889.30 | $2,094.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.87 / $850.01 / $1,576.54
| Professional | | $574.87 | $850.01 | $1,576.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,720.00 / $16,547.20 / $26,542.00
| Facility | | $3,720.00 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,007.80 / $5,007.80 / $5,692.80
| Professional | | $5,007.80 | $5,007.80 | $5,692.80 |