- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.34 / $10,087.00 / $11,986.00
| Facility | | $753.34 | $10,087.00 | $11,986.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.61 / $566.54 / $1,060.96
| Professional | | $510.61 | $566.54 | $1,060.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.95 / $2,998.55 / $5,088.43
| Facility | | $2,725.95 | $2,998.55 | $5,088.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.68 / $956.33 / $1,500.49
| Professional | | $663.68 | $956.33 | $1,500.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.83 / $3,390.19 / $5,654.79
| Facility | | $652.83 | $3,390.19 | $5,654.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.07 / $840.87 / $1,442.69
| Professional | | $606.07 | $840.87 | $1,442.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.34 / $670.12 / $1,033.52
| Facility | | $564.34 | $670.12 | $1,033.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.00 / $859.00 / $2,016.98
| Professional | | $740.00 | $859.00 | $2,016.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.70 / $699.30 / $1,191.40
| Professional | | $583.70 | $699.30 | $1,191.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.00 / $2,050.00 / $15,712.00
| Facility | | $1,461.00 | $2,050.00 | $15,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.44 / $651.21 / $1,428.83
| Professional | | $493.44 | $651.21 | $1,428.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,764.95 / $16,547.20 / $26,542.00
| Facility | | $3,764.95 | $16,547.20 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,481.71 / $8,481.71 / $8,481.71
| Professional | | $8,481.71 | $8,481.71 | $8,481.71 |