- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,801.89 / $8,511.38
| Facility | | $436.52 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $1,122.02
| Professional | | $190.55 | $338.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $173.78 / $446.68
| Professional | | $87.10 | $173.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,623.41 / $10,964.78
| Facility | | $4,265.80 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $645.65
| Professional | | $245.47 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $630.96 / $794.33
| Professional | | $281.84 | $630.96 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $501.19 / $3,019.95
| Facility | | $275.42 | $501.19 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $2,511.89
| Professional | | $407.38 | $707.95 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,000.00
| Professional | | $478.63 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $741.31
| Professional | | $467.74 | $660.69 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,162.28 / $8,128.31
| Facility | | $977.24 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $478.63 / $812.83
| Professional | | $275.42 | $478.63 | $812.83 |