- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.28 / $1,245.00 / $8,413.00
| Facility | | $690.28 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.62 / $712.64 / $1,280.34
| Professional | | $656.62 | $712.64 | $1,280.34 |
- 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
- $771.15 / $1,048.21 / $1,759.70
| Professional | | $771.15 | $1,048.21 | $1,759.70 |
- 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
- $721.44 / $986.88 / $1,585.49
| Professional | | $721.44 | $986.88 | $1,585.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.28 / $869.44 / $1,373.68
| Facility | | $690.28 | $869.44 | $1,373.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $790.00 / $897.00
| Professional | | $579.00 | $790.00 | $897.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.11 / $1,044.65 / $1,165.91
| Professional | | $915.11 | $1,044.65 | $1,165.91 |
- 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
- $551.45 / $775.86 / $1,617.29
| Professional | | $551.45 | $775.86 | $1,617.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,577.60 / $8,957.00 / $26,542.00
| Facility | | $2,577.60 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,008.64 / $5,008.64 / $5,958.83
| Professional | | $5,008.64 | $5,008.64 | $5,958.83 |