- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.58 / $1,245.00 / $10,561.00
| Facility | | $749.58 | $1,245.00 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.12 / $763.43 / $1,399.30
| Professional | | $664.12 | $763.43 | $1,399.30 |
- 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
- $845.83 / $1,141.36 / $1,930.12
| Professional | | $845.83 | $1,141.36 | $1,930.12 |
- 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
- $788.77 / $1,076.61 / $1,742.79
| Professional | | $788.77 | $1,076.61 | $1,742.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.58 / $944.95 / $1,504.74
| Facility | | $749.58 | $944.95 | $1,504.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.00 / $868.00 / $974.00
| Professional | | $716.00 | $868.00 | $974.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,002.60 / $1,895.20
| Professional | | $3.00 | $1,002.60 | $1,895.20 |
- 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
- $603.16 / $889.65 / $1,920.27
| Professional | | $603.16 | $889.65 | $1,920.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,802.16 / $8,957.00 / $26,542.00
| Facility | | $2,802.16 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,439.20 / $5,439.20 / $6,474.08
| Professional | | $5,439.20 | $5,439.20 | $6,474.08 |