- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,265.80 / $8,317.64
| Facility | | $831.76 | $4,265.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,412.54
| Professional | | $436.52 | $524.81 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $1,047.13
| Professional | | $562.34 | $912.01 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $954.99
| Professional | | $426.58 | $575.44 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $912.01 / $1,000.00
| Professional | | $707.95 | $912.01 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,096.48
| Professional | | $478.63 | $691.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,801.89 / $8,317.64
| Facility | | $831.76 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $1,737.80
| Professional | | $436.52 | $588.84 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $562.34
| Facility | | $446.68 | $512.86 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $575.44
| Professional | | $446.68 | $512.86 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,754.23 / $6,606.93
| Facility | | $812.83 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $562.34 / $1,000.00
| Professional | | $407.38 | $562.34 | $1,000.00 |