- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $6,025.60
| Facility | | $977.24 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $831.76 / $2,344.23
| Professional | | $630.96 | $831.76 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $1,318.26
| Professional | | $724.44 | $1,000.00 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,090.30
| Professional | | $32.36 | $33.11 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,918.31 / $13,803.84
| Facility | | $5,888.44 | $6,918.31 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $1,949.84
| Professional | | $758.58 | $1,122.02 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,000.00 / $1,584.89
| Professional | | $758.58 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,041.74
| Professional | | $851.14 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $1,230.27
| Professional | | $616.60 | $812.83 | $1,230.27 |