- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.92 / $2,704.85 / $5,048.00
| Facility | | $693.92 | $2,704.85 | $5,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.82 / $521.38 / $1,414.70
| Professional | | $384.82 | $521.38 | $1,414.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $4,402.00 / $11,102.00
| Facility | | $818.35 | $4,402.00 | $11,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.72 / $727.55 / $1,646.14
| Professional | | $415.72 | $727.55 | $1,646.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.65 / $718.66 / $1,230.97
| Professional | | $523.65 | $718.66 | $1,230.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.59 / $1,038.52 / $6,679.00
| Facility | | $480.59 | $1,038.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.04 / $662.06 / $913.90
| Professional | | $531.04 | $662.06 | $913.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.61 / $1,132.47 / $1,695.88
| Professional | | $597.61 | $1,132.47 | $1,695.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.94 / $869.94 / $1,626.89
| Facility | | $869.94 | $869.94 | $1,626.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.14 / $1,383.14 / $1,452.29
| Professional | | $1,383.14 | $1,383.14 | $1,452.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,268.00 / $11,102.00
| Facility | | $55.00 | $5,268.00 | $11,102.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.57 / $728.42 / $3,475.60
| Professional | | $507.57 | $728.42 | $3,475.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.44 / $726.96 / $1,558.60
| Professional | | $504.44 | $726.96 | $1,558.60 |