- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,090.30 / $5,623.41
| Facility | | $724.44 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $891.25 / $2,754.23
| Professional | | $316.23 | $891.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,677.35 / $45,708.82
| Facility | | $812.83 | $4,677.35 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,023.29 / $3,019.95
| Professional | | $354.81 | $1,023.29 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,174.90
| Facility | | $501.19 | $501.19 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $2,041.74
| Professional | | $851.14 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,148.15 / $2,754.23
| Professional | | $426.58 | $1,148.15 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $851.14 / $7,079.46
| Facility | | $389.05 | $851.14 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $1,995.26
| Professional | | $1,148.15 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,023.29 / $2,454.71
| Professional | | $457.09 | $1,023.29 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $3,467.37
| Facility | | $331.13 | $331.13 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $45,708.82
| Facility | | $851.14 | $4,677.35 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,000.00 / $2,884.03
| Professional | | $354.81 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,000.00 / $2,511.89
| Professional | | $389.05 | $1,000.00 | $2,511.89 |