- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $2,073.66 / $4,392.00
| Facility | | $762.00 | $2,073.66 | $4,392.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.35 / $2,159.46 / $2,918.65
| Professional | | $1,506.35 | $2,159.46 | $2,918.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,487.42 / $10,814.26 / $15,783.31
| Facility | | $6,487.42 | $10,814.26 | $15,783.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.62 / $2,140.44 / $2,990.05
| Professional | | $1,773.62 | $2,140.44 | $2,990.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.60 / $8,083.18 / $8,083.18
| Facility | | $1,458.60 | $8,083.18 | $8,083.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,589.38 / $2,255.91 / $3,132.01
| Professional | | $1,589.38 | $2,255.91 | $3,132.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.00 / $6,420.00 / $14,900.00
| Facility | | $1,284.00 | $6,420.00 | $14,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,463.25 / $1,851.18 / $3,471.10
| Professional | | $1,463.25 | $1,851.18 | $3,471.10 |