- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.51 / $1,181.00 / $7,439.00
| Facility | | $553.51 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.51 / $583.41 / $1,036.64
| Professional | | $553.51 | $583.41 | $1,036.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,503.36 / $2,503.36 / $2,539.89
| Facility | | $2,503.36 | $2,503.36 | $2,539.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.00 / $848.60 / $1,487.07
| Professional | | $583.00 | $848.60 | $1,487.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $3,495.99
| Facility | | $530.04 | $530.04 | $3,495.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.02 / $795.76 / $1,402.18
| Professional | | $589.02 | $795.76 | $1,402.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.51 / $721.16 / $1,114.44
| Facility | | $553.51 | $721.16 | $1,114.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $697.00 / $740.00
| Professional | | $507.00 | $697.00 | $740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $754.70 / $1,468.60
| Professional | | $5.00 | $754.70 | $1,468.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.94 / $671.42 / $1,361.27
| Professional | | $467.94 | $671.42 | $1,361.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,209.40 / $11,553.65 / $16,394.00
| Facility | | $3,209.40 | $11,553.65 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,294.39 / $4,294.39 / $4,928.47
| Professional | | $4,294.39 | $4,294.39 | $4,928.47 |