- 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
- $681.83 / $730.98 / $1,339.56
| Professional | | $681.83 | $730.98 | $1,339.56 |
- 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
- $885.13 / $1,169.93 / $1,875.16
| Professional | | $885.13 | $1,169.93 | $1,875.16 |
- 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
- $763.59 / $1,067.14 / $1,774.52
| Professional | | $763.59 | $1,067.14 | $1,774.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.71 / $1,000.06 / $1,571.11
| Facility | | $716.71 | $1,000.06 | $1,571.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $902.00 / $953.00
| Professional | | $579.00 | $902.00 | $953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $970.30 / $1,804.60
| Professional | | $3.00 | $970.30 | $1,804.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,306.00 / $10,761.00 / $17,120.00
| Facility | | $3,306.00 | $10,761.00 | $17,120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.29 / $857.30 / $1,765.66
| Professional | | $606.29 | $857.30 | $1,765.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.56 / $8,957.00 / $26,542.00
| Facility | | $2,758.56 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,819.43 / $5,819.43 / $6,350.70
| Professional | | $5,819.43 | $5,819.43 | $6,350.70 |