- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.75 / $1,245.00 / $8,413.00
| Facility | | $710.75 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.66 / $746.75 / $1,320.29
| Professional | | $685.66 | $746.75 | $1,320.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.39 / $1,863.39 / $2,662.55
| Facility | | $1,863.39 | $1,863.39 | $2,662.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.65 / $1,133.02 / $1,904.72
| Professional | | $839.65 | $1,133.02 | $1,904.72 |
- 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
- $763.77 / $1,059.02 / $1,694.84
| Professional | | $763.77 | $1,059.02 | $1,694.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.75 / $892.89 / $1,509.28
| Facility | | $710.75 | $892.89 | $1,509.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $846.00 / $921.00
| Professional | | $579.00 | $846.00 | $921.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.32 / $1,070.63 / $1,174.33
| Professional | | $917.32 | $1,070.63 | $1,174.33 |
- 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
- $584.21 / $830.65 / $1,818.49
| Professional | | $584.21 | $830.65 | $1,818.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,642.36 / $8,957.00 / $26,542.00
| Facility | | $2,642.36 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,375.57 / $5,375.57 / $6,100.28
| Professional | | $5,375.57 | $5,375.57 | $6,100.28 |