- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.00 / $1,615.00 / $7,439.00
| Facility | | $903.00 | $1,615.00 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.96 / $1,112.77 / $1,213.42
| Professional | | $224.96 | $1,112.77 | $1,213.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.09 / $2,177.25 / $3,169.06
| Professional | | $1,402.09 | $2,177.25 | $3,169.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,590.23 / $6,590.23 / $6,590.23
| Professional | | $6,590.23 | $6,590.23 | $6,590.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.20 / $1,080.20 / $1,446.60
| Facility | | $1,080.20 | $1,080.20 | $1,446.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.20 / $1,080.20 / $1,836.00
| Professional | | $1,080.20 | $1,080.20 | $1,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.70 / $806.70 / $806.70
| Professional | | $806.70 | $806.70 | $806.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.00 / $3,994.00 / $6,543.00
| Facility | | $806.00 | $3,994.00 | $6,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.72 / $1,501.47 / $3,125.43
| Professional | | $981.72 | $1,501.47 | $3,125.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,741.47 / $4,566.17 / $7,159.39
| Facility | | $2,741.47 | $4,566.17 | $7,159.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,263.44 / $12,296.63 / $12,296.63
| Professional | | $10,263.44 | $12,296.63 | $12,296.63 |