- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.85 / $1,245.00 / $8,413.00
| Facility | | $594.85 | $1,245.00 | $8,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.85 / $626.62 / $1,111.65
| Professional | | $594.85 | $626.62 | $1,111.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,863.39 / $1,863.39 / $2,662.55
| Facility | | $1,863.39 | $1,863.39 | $2,662.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.23 / $953.19 / $1,595.20
| Professional | | $689.23 | $953.19 | $1,595.20 |
- 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
- $658.85 / $863.01 / $1,506.42
| Professional | | $658.85 | $863.01 | $1,506.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.85 / $729.16 / $1,325.00
| Facility | | $594.85 | $729.16 | $1,325.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $740.00 / $792.00
| Professional | | $579.00 | $740.00 | $792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $806.80 / $1,595.10
| Professional | | $3.00 | $806.80 | $1,595.10 |
- 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
- $517.63 / $752.26 / $1,464.92
| Professional | | $517.63 | $752.26 | $1,464.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.52 / $19,913.50 / $26,542.00
| Facility | | $2,291.52 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,277.83 / $5,404.02 / $5,404.02
| Professional | | $5,277.83 | $5,404.02 | $5,404.02 |