- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.75 / $2,618.00 / $3,625.00
| Facility | | $513.75 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.21 / $513.75 / $867.36
| Professional | | $255.21 | $513.75 | $867.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.20 / $3,764.00 / $12,379.00
| Facility | | $585.20 | $3,764.00 | $12,379.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.23 / $854.08 / $4,281.97
| Professional | | $283.23 | $854.08 | $4,281.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.82 / $366.37 / $718.64
| Facility | | $281.82 | $366.37 | $718.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.36 / $830.92 / $1,676.84
| Professional | | $353.36 | $830.92 | $1,676.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.82 / $513.86 / $6,679.00
| Facility | | $246.82 | $513.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.61 / $627.04 / $956.86
| Professional | | $325.61 | $627.04 | $956.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.26 / $670.46 / $1,401.30
| Professional | | $310.26 | $670.46 | $1,401.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.28 / $4,249.00 / $16,394.00
| Facility | | $1,201.28 | $4,249.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.05 / $1,366.64 / $4,281.97
| Professional | | $624.05 | $1,366.64 | $4,281.97 |
- 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
- $616.84 / $969.14 / $1,987.09
| Professional | | $616.84 | $969.14 | $1,987.09 |