- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,344.23 / $8,511.38
| Facility | | $707.95 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $1,348.96
| Professional | | $316.23 | $524.81 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $660.69
| Professional | | $331.13 | $446.68 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,165.95 / $12,022.64
| Facility | | $4,677.35 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $1,000.00
| Professional | | $407.38 | $676.08 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $1,513.56
| Professional | | $562.34 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $4,073.80
| Facility | | $436.52 | $660.69 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $3,890.45
| Professional | | $549.54 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $1,513.56
| Professional | | $794.33 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,621.81
| Professional | | $812.83 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,897.79 / $8,128.31
| Facility | | $3,630.78 | $4,897.79 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,230.27
| Professional | | $426.58 | $741.31 | $1,230.27 |