- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.86 / $1,615.00 / $10,561.00
| Facility | | $650.86 | $1,615.00 | $10,561.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.91 / $684.83 / $1,312.16
| Professional | | $631.91 | $684.83 | $1,312.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.75 / $2,094.75 / $2,993.14
| Facility | | $2,094.75 | $2,094.75 | $2,993.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.66 / $1,174.06 / $1,753.00
| Professional | | $755.66 | $1,174.06 | $1,753.00 |
- 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
- $727.66 / $930.97 / $1,659.27
| Professional | | $727.66 | $930.97 | $1,659.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.86 / $895.00 / $1,325.69
| Facility | | $650.86 | $895.00 | $1,325.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.37 / $823.00 / $865.00
| Professional | | $802.37 | $823.00 | $865.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $880.30 / $1,751.70
| Professional | | $5.00 | $880.30 | $1,751.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $9,447.00 / $14,257.00
| Facility | | $2,629.00 | $9,447.00 | $14,257.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.72 / $828.04 / $1,864.34
| Professional | | $572.72 | $828.04 | $1,864.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $17,381.18 / $19,913.50
| Facility | | $55.00 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,719.42 / $5,719.42 / $5,764.05
| Professional | | $5,719.42 | $5,719.42 | $5,764.05 |