- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.05 / $1,181.00 / $7,439.00
| Facility | | $622.05 | $1,181.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.05 / $655.04 / $1,164.57
| Professional | | $622.05 | $655.04 | $1,164.57 |
- 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
- $554.55 / $1,147.09 / $1,768.44
| Professional | | $554.55 | $1,147.09 | $1,768.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $6,025.59
| Facility | | $530.04 | $530.04 | $6,025.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.89 / $1,024.81 / $1,567.50
| Professional | | $713.89 | $1,024.81 | $1,567.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.05 / $875.72 / $1,418.96
| Facility | | $622.05 | $875.72 | $1,418.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.00 / $774.00 / $831.00
| Professional | | $507.00 | $774.00 | $831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.10 / $973.28 / $1,065.38
| Professional | | $848.10 | $973.28 | $1,065.38 |
- 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
- $558.00 / $856.68 / $1,527.93
| Professional | | $558.00 | $856.68 | $1,527.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.28 / $17,381.18 / $19,913.50
| Facility | | $2,403.28 | $17,381.18 | $19,913.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,496.96 / $5,496.96 / $5,536.58
| Professional | | $5,496.96 | $5,496.96 | $5,536.58 |