- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,388.44 / $5,623.41
| Facility | | $741.31 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,380.38 / $4,365.16
| Professional | | $741.31 | $1,380.38 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,244.36
| Facility | | $56.23 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,621.81 / $12,022.64
| Professional | | $851.14 | $1,621.81 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $3,981.07
| Professional | | $1,412.54 | $2,290.87 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,778.28 / $8,511.38
| Facility | | $302.00 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,513.56 / $2,344.23
| Professional | | $1,258.93 | $1,513.56 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $2,951.21
| Professional | | $1,096.48 | $1,548.82 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,244.36
| Facility | | $56.23 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,621.81 / $12,022.64
| Professional | | $851.14 | $1,621.81 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $4,677.35
| Facility | | $1,000.00 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,737.80 / $3,388.44
| Professional | | $1,288.25 | $1,737.80 | $3,388.44 |