- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.59 / $1,181.00 / $7,439.00
| Facility | | $511.59 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.59 / $539.16 / $994.44
| Professional | | $511.59 | $539.16 | $994.44 |
- 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
- $652.34 / $962.11 / $1,457.58
| Professional | | $652.34 | $962.11 | $1,457.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $2,710.28
| Facility | | $530.04 | $530.04 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.16 / $888.37 / $1,290.85
| Professional | | $587.16 | $888.37 | $1,290.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.59 / $744.00 / $1,207.34
| Facility | | $511.59 | $744.00 | $1,207.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $642.00 / $685.00
| Professional | | $507.00 | $642.00 | $685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $699.50 / $1,414.00
| Professional | | $3.00 | $699.50 | $1,414.00 |
- 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
- $458.92 / $704.60 / $1,256.69
| Professional | | $458.92 | $704.60 | $1,256.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $8,957.00 / $16,394.00
| Facility | | $1,981.00 | $8,957.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,565.78 / $5,085.35 / $5,085.35
| Professional | | $4,565.78 | $5,085.35 | $5,085.35 |