- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.96 / $1,245.00 / $8,413.00
| Facility | | $733.96 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.96 / $772.31 / $1,425.03
| Professional | | $733.96 | $772.31 | $1,425.03 |
- 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
- $854.55 / $1,191.71 / $1,979.87
| Professional | | $854.55 | $1,191.71 | $1,979.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $822.80 / $1,055.84 / $1,877.32
| Professional | | $822.80 | $1,055.84 | $1,877.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.96 / $976.00 / $1,499.01
| Facility | | $733.96 | $976.00 | $1,499.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $931.00 / $975.00
| Professional | | $579.00 | $931.00 | $975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $992.00 / $1,979.00
| Professional | | $4.00 | $992.00 | $1,979.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,306.00 / $12,081.00 / $18,765.00
| Facility | | $3,306.00 | $12,081.00 | $18,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.30 / $935.00 / $1,996.80
| Professional | | $644.30 | $935.00 | $1,996.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,532.85 / $19,913.50 / $26,542.00
| Facility | | $3,532.85 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,455.60 / $5,455.60 / $6,505.95
| Professional | | $5,455.60 | $5,455.60 | $6,505.95 |