- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.96 / $1,245.00 / $8,413.00
| Facility | | $681.96 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.96 / $717.30 / $1,322.69
| Professional | | $681.96 | $717.30 | $1,322.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.67 / $1,019.27 / $1,787.17
| Professional | | $730.67 | $1,019.27 | $1,787.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $3,521.48
| Facility | | $606.10 | $606.10 | $3,521.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.38 / $958.44 / $1,740.77
| Professional | | $722.38 | $958.44 | $1,740.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.96 / $909.28 / $1,350.67
| Facility | | $681.96 | $909.28 | $1,350.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $797.00 / $907.00
| Professional | | $579.00 | $797.00 | $907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $923.70 / $1,799.70
| Professional | | $4.00 | $923.70 | $1,799.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.64 / $813.71 / $1,852.59
| Professional | | $576.64 | $813.71 | $1,852.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,284.40 / $11,637.85 / $26,542.00
| Facility | | $3,284.40 | $11,637.85 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,704.57 / $5,704.57 / $6,049.28
| Professional | | $5,704.57 | $5,704.57 | $6,049.28 |