- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.37 / $1,245.00 / $7,278.00
| Facility | | $655.37 | $1,245.00 | $7,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.11 / $675.03 / $1,006.97
| Professional | | $618.11 | $675.03 | $1,006.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.61 / $496.77 / $843.00
| Facility | | $451.61 | $496.77 | $843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.57 / $1,172.21 / $1,758.39
| Professional | | $723.57 | $1,172.21 | $1,758.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $3,799.24 / $7,167.25
| Facility | | $515.00 | $3,799.24 | $7,167.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.95 / $976.50 / $1,651.06
| Professional | | $675.95 | $976.50 | $1,651.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.37 / $750.37 / $1,156.51
| Facility | | $655.37 | $750.37 | $1,156.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.87 / $919.00 / $3,138.74
| Professional | | $560.87 | $919.00 | $3,138.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,403.20 / $1,767.80
| Professional | | $5.00 | $1,403.20 | $1,767.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.00 / $5,293.00 / $15,712.00
| Facility | | $1,503.00 | $5,293.00 | $15,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $755.48 / $1,583.08
| Professional | | $549.54 | $755.48 | $1,583.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,669.06 / $20,973.00
| Facility | | $55.00 | $3,669.06 | $20,973.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,801.92 / $4,801.92 / $5,613.83
| Professional | | $4,801.92 | $4,801.92 | $5,613.83 |