- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.33 / $1,338.00 / $10,768.00
| Facility | | $528.33 | $1,338.00 | $10,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.33 / $557.72 / $991.71
| Professional | | $528.33 | $557.72 | $991.71 |
- 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
- $581.21 / $1,043.47 / $1,419.65
| Professional | | $581.21 | $1,043.47 | $1,419.65 |
- 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
- $571.91 / $737.92 / $1,315.90
| Professional | | $571.91 | $737.92 | $1,315.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.33 / $618.63 / $1,042.81
| Facility | | $528.33 | $618.63 | $1,042.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $657.00 / $710.00
| Professional | | $579.00 | $657.00 | $710.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $726.10 / $1,431.70
| Professional | | $3.00 | $726.10 | $1,431.70 |
- 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
- $448.02 / $653.65 / $1,416.25
| Professional | | $448.02 | $653.65 | $1,416.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.71 / $8,957.00 / $26,542.00
| Facility | | $2,052.71 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,970.80 / $3,970.80 / $4,732.64
| Professional | | $3,970.80 | $3,970.80 | $4,732.64 |