- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.16 / $1,410.00 / $12,615.00
| Facility | | $711.16 | $1,410.00 | $12,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.24 / $744.69 / $1,375.94
| Professional | | $676.24 | $744.69 | $1,375.94 |
- 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
- $818.87 / $1,321.11 / $1,792.94
| Professional | | $818.87 | $1,321.11 | $1,792.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.10 / $852.10 / $2,710.28
| Facility | | $852.10 | $852.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.33 / $1,048.63 / $1,663.49
| Professional | | $759.33 | $1,048.63 | $1,663.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.16 / $897.46 / $1,457.07
| Facility | | $711.16 | $897.46 | $1,457.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.37 / $829.00 / $922.00
| Professional | | $808.37 | $829.00 | $922.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,116.07 / $1,832.20
| Professional | | $3.00 | $1,116.07 | $1,832.20 |
- 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
- $576.24 / $806.25 / $1,663.54
| Professional | | $576.24 | $806.25 | $1,663.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,646.92 / $8,957.00 / $26,542.00
| Facility | | $2,646.92 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,157.76 / $5,157.76 / $6,104.18
| Professional | | $5,157.76 | $5,157.76 | $6,104.18 |