- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.44 / $1,245.00 / $10,561.00
| Facility | | $844.44 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.28 / $844.44 / $1,564.90
| Professional | | $803.28 | $844.44 | $1,564.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.87 / $2,226.87 / $2,259.36
| Facility | | $2,226.87 | $2,226.87 | $2,259.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.36 / $1,473.73 / $2,114.80
| Professional | | $869.36 | $1,473.73 | $2,114.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.39 / $1,139.02 / $1,866.22
| Professional | | $846.39 | $1,139.02 | $1,866.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.44 / $1,015.72 / $1,668.67
| Facility | | $844.44 | $1,015.72 | $1,668.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.00 / $838.00 / $1,094.00
| Professional | | $716.00 | $838.00 | $1,094.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,125.00 / $1,818.70
| Professional | | $3.00 | $1,125.00 | $1,818.70 |
- 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
- $661.64 / $944.03 / $1,991.39
| Professional | | $661.64 | $944.03 | $1,991.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,149.56 / $8,957.00 / $26,542.00
| Facility | | $3,149.56 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,130.51 / $6,130.51 / $7,273.73
| Professional | | $6,130.51 | $6,130.51 | $7,273.73 |