- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.74 / $1,245.00 / $8,413.00
| Facility | | $583.74 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.74 / $615.11 / $1,097.43
| Professional | | $583.74 | $615.11 | $1,097.43 |
- 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
- $683.65 / $963.92 / $1,630.04
| Professional | | $683.65 | $963.92 | $1,630.04 |
- 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
- $669.48 / $891.15 / $1,482.02
| Professional | | $669.48 | $891.15 | $1,482.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.74 / $830.00 / $1,273.20
| Facility | | $583.74 | $830.00 | $1,273.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $727.00 / $778.00
| Professional | | $579.00 | $727.00 | $778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $792.50 / $1,578.40
| Professional | | $4.00 | $792.50 | $1,578.40 |
- 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
- $512.82 / $718.70 / $1,582.14
| Professional | | $512.82 | $718.70 | $1,582.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,813.55 / $19,913.50 / $26,542.00
| Facility | | $2,813.55 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,520.10 / $4,520.10 / $5,182.64
| Professional | | $4,520.10 | $4,520.10 | $5,182.64 |