- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.71 / $1,245.00 / $8,413.00
| Facility | | $716.71 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.71 / $754.70 / $1,341.34
| Professional | | $716.71 | $754.70 | $1,341.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.09 / $3,665.09 / $3,718.57
| Facility | | $3,665.09 | $3,665.09 | $3,718.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.40 / $1,101.04 / $1,939.86
| Professional | | $795.40 | $1,101.04 | $1,939.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.74 / $1,007.61 / $1,832.68
| Professional | | $763.74 | $1,007.61 | $1,832.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.71 / $867.43 / $1,399.06
| Facility | | $716.71 | $867.43 | $1,399.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.43 / $910.00 / $956.00
| Professional | | $867.43 | $910.00 | $956.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $973.50 / $1,870.20
| Professional | | $3.00 | $973.50 | $1,870.20 |
- 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
- $611.76 / $846.16 / $1,771.45
| Professional | | $611.76 | $846.16 | $1,771.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,817.95 / $8,957.00
| Facility | | $55.00 | $7,817.95 | $8,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,347.44 / $5,347.44 / $6,370.50
| Professional | | $5,347.44 | $5,347.44 | $6,370.50 |