- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.11 / $1,181.00 / $7,439.00
| Facility | | $792.11 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.57 / $792.11 / $1,691.78
| Professional | | $759.57 | $792.11 | $1,691.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.84 / $1,133.46 / $1,845.48
| Professional | | $401.84 | $1,133.46 | $1,845.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $6,025.59
| Facility | | $530.04 | $530.04 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.14 / $1,035.93 / $1,750.57
| Professional | | $753.14 | $1,035.93 | $1,750.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.11 / $894.00 / $1,579.28
| Facility | | $792.11 | $894.00 | $1,579.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $661.00 / $1,180.00
| Professional | | $507.00 | $661.00 | $1,180.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $1,215.59 / $1,753.50
| Professional | | $6.00 | $1,215.59 | $1,753.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.25 / $929.74 / $2,068.53
| Professional | | $624.25 | $929.74 | $2,068.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,931.31 / $17,381.18 / $19,913.50
| Facility | | $5,931.31 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,584.16 / $6,584.16 / $7,833.90
| Professional | | $6,584.16 | $6,584.16 | $7,833.90 |