- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.64 / $1,350.00 / $7,439.00
| Facility | | $587.64 | $1,350.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.64 / $587.64 / $770.28
| Professional | | $587.64 | $587.64 | $770.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,807.46 / $6,807.46 / $6,906.79
| Facility | | $6,807.46 | $6,807.46 | $6,906.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.45 / $493.20 / $723.78
| Professional | | $360.45 | $493.20 | $723.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $13,652.00
| Facility | | $606.10 | $606.10 | $13,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.25 / $842.81 / $1,486.35
| Professional | | $630.25 | $842.81 | $1,486.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.64 / $625.10 / $1,049.41
| Facility | | $451.64 | $625.10 | $1,049.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $725.84 / $725.84 / $776.00
| Professional | | $725.84 | $725.84 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $739.10 / $1,203.57
| Professional | | $13.00 | $739.10 | $1,203.57 |
- 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
- $246.51 / $401.39 / $705.36
| Professional | | $246.51 | $401.39 | $705.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,897.00 / $9,651.74 / $9,651.74
| Facility | | $5,897.00 | $9,651.74 | $9,651.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,334.47 / $5,192.93 / $5,192.93
| Professional | | $4,334.47 | $5,192.93 | $5,192.93 |