- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.75 / $2,618.00 / $3,625.00
| Facility | | $378.75 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.40 / $413.32 / $792.26
| Professional | | $243.40 | $413.32 | $792.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $2,854.00 / $9,039.00
| Facility | | $818.35 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.21 / $758.85 / $2,394.88
| Professional | | $369.21 | $758.85 | $2,394.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.26 / $512.54 / $904.43
| Facility | | $394.26 | $512.54 | $904.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.51 / $763.42 / $1,553.93
| Professional | | $413.51 | $763.42 | $1,553.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.09 / $718.90 / $6,679.00
| Facility | | $332.09 | $718.90 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.13 / $738.81 / $1,021.06
| Professional | | $583.13 | $738.81 | $1,021.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.88 / $875.31 / $1,553.18
| Professional | | $412.88 | $875.31 | $1,553.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.61 / $3,764.00 / $16,394.00
| Facility | | $1,677.61 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.77 / $944.24 / $3,754.80
| Professional | | $533.77 | $944.24 | $3,754.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.83 / $724.56 / $1,440.71
| Professional | | $459.83 | $724.56 | $1,440.71 |