- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,801.89 / $12,589.25
| Facility | | $977.24 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $2,344.23
| Professional | | $389.05 | $524.81 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $14,125.38
| Facility | | $5,623.41 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $933.25
| Professional | | $398.11 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,000.00 / $1,348.96
| Professional | | $446.68 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $4,786.30
| Facility | | $426.58 | $741.31 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $933.25 / $3,981.07
| Professional | | $602.56 | $933.25 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,047.13 / $1,380.38
| Professional | | $933.25 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,023.29
| Professional | | $954.99 | $954.99 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $870.96 / $1,148.15
| Professional | | $3.02 | $870.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $8,128.31
| Facility | | $3,630.78 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,071.52
| Professional | | $575.44 | $831.76 | $1,071.52 |