- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.15 / $6,735.00 / $10,134.00
| Facility | | $499.15 | $6,735.00 | $10,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.15 / $530.74 / $1,007.68
| Professional | | $499.15 | $530.74 | $1,007.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.06 / $2,297.06 / $2,330.58
| Facility | | $2,297.06 | $2,297.06 | $2,330.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.10 / $808.62 / $1,406.34
| Professional | | $579.10 | $808.62 | $1,406.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,710.28
| Facility | | $606.10 | $606.10 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.01 / $717.43 / $1,261.17
| Professional | | $559.01 | $717.43 | $1,261.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.15 / $617.00 / $1,071.80
| Facility | | $499.15 | $617.00 | $1,071.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $624.00 / $667.00
| Professional | | $579.00 | $624.00 | $667.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $680.40 / $1,348.10
| Professional | | $4.00 | $680.40 | $1,348.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.09 / $597.71 / $1,232.91
| Professional | | $437.09 | $597.71 | $1,232.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,414.55 / $8,957.00 / $26,542.00
| Facility | | $2,414.55 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,644.56 / $4,644.56 / $4,644.56
| Professional | | $4,644.56 | $4,644.56 | $4,644.56 |