- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,630.78 / $5,128.61
| Facility | | $812.83 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,445.44
| Professional | | $776.25 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,818.38 / $8,317.64
| Facility | | $1,905.46 | $2,818.38 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,659.59 / $6,606.93
| Professional | | $707.95 | $1,659.59 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,479.11 / $2,089.30
| Facility | | $1,174.90 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,348.96 / $2,818.38
| Facility | | $831.76 | $1,348.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,570.40
| Professional | | $2,137.96 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,951.21
| Professional | | $2,511.89 | $2,511.89 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $3,715.35
| Professional | | $1,737.80 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,818.38 / $8,317.64
| Facility | | $1,905.46 | $2,818.38 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,737.80 / $6,606.93
| Professional | | $707.95 | $1,737.80 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $1,737.80
| Facility | | $1,047.13 | $1,584.89 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $2,398.83
| Professional | | $707.95 | $1,174.90 | $2,398.83 |