- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.31 / $1,245.00 / $8,413.00
| Facility | | $682.31 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.31 / $718.96 / $1,275.45
| Professional | | $682.31 | $718.96 | $1,275.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.09 / $3,665.09 / $3,718.57
| Facility | | $3,665.09 | $3,665.09 | $3,718.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.34 / $1,310.13 / $1,842.42
| Professional | | $780.34 | $1,310.13 | $1,842.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $7,599.28
| Facility | | $606.10 | $606.10 | $7,599.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.64 / $982.42 / $1,742.40
| Professional | | $736.64 | $982.42 | $1,742.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.31 / $935.34 / $1,360.03
| Facility | | $682.31 | $935.34 | $1,360.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $850.00 / $908.00
| Professional | | $579.00 | $850.00 | $908.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $924.10 / $1,836.40
| Professional | | $4.00 | $924.10 | $1,836.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,183.00 / $12,216.00 / $19,066.00
| Facility | | $3,183.00 | $12,216.00 | $19,066.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.28 / $854.82 / $1,924.59
| Professional | | $582.28 | $854.82 | $1,924.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.95 / $25,114.25 / $26,542.00
| Facility | | $3,285.95 | $25,114.25 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,078.08 / $5,078.08 / $6,051.83
| Professional | | $5,078.08 | $5,078.08 | $6,051.83 |