- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.31 / $1,266.69 / $10,561.00
| Facility | | $737.31 | $1,266.69 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.31 / $761.61 / $1,493.34
| Professional | | $737.31 | $761.61 | $1,493.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,474.86 / $3,474.86 / $3,525.56
| Facility | | $3,474.86 | $3,474.86 | $3,525.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.79 / $1,244.31 / $2,087.01
| Professional | | $713.79 | $1,244.31 | $2,087.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,393.27
| Facility | | $748.70 | $748.70 | $2,393.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.90 / $1,091.34 / $1,966.85
| Professional | | $835.90 | $1,091.34 | $1,966.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.31 / $981.16 / $1,594.11
| Facility | | $737.31 | $981.16 | $1,594.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.00 / $1,004.00 / $1,004.00
| Professional | | $716.00 | $1,004.00 | $1,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $981.80 / $2,201.10
| Professional | | $5.00 | $981.80 | $2,201.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.82 / $923.75 / $1,976.59
| Professional | | $653.82 | $923.75 | $1,976.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.47 / $7,909.30 / $26,542.00
| Facility | | $4,200.47 | $7,909.30 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,223.58 / $7,223.58 / $7,223.58
| Professional | | $7,223.58 | $7,223.58 | $7,223.58 |