- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,524.00 / $22,312.00 / $37,718.00
| Facility | | $12,524.00 | $22,312.00 | $37,718.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $183.01 / $257.83
| Professional | | $143.82 | $183.01 | $257.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.46 / $604.07 / $22,577.00
| Professional | | $447.46 | $604.07 | $22,577.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.51 / $982.21 / $1,211.39
| Professional | | $818.51 | $982.21 | $1,211.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.27 / $164.40 / $850.66
| Facility | | $127.27 | $164.40 | $850.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.00 / $1,031.00 / $1,362.62
| Professional | | $899.00 | $1,031.00 | $1,362.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.76 / $9,929.00 / $41,410.00
| Facility | | $534.76 | $9,929.00 | $41,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.76 / $9,929.00 / $41,410.00
| Professional | | $534.76 | $9,929.00 | $41,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.97 / $159.08 / $250.42
| Professional | | $100.97 | $159.08 | $250.42 |