- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,388.44 / $5,623.41
| Facility | | $851.14 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,584.89 / $5,011.87
| Professional | | $851.14 | $1,584.89 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $12,882.50
| Professional | | $977.24 | $1,862.09 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $4,677.35
| Professional | | $1,659.59 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,995.26 / $8,511.38
| Facility | | $302.00 | $1,995.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $2,754.23
| Professional | | $1,445.44 | $1,737.80 | $2,754.23 |
- 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
- $1,288.25 / $1,819.70 / $3,388.44
| Professional | | $1,288.25 | $1,819.70 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $12,882.50
| Professional | | $977.24 | $1,862.09 | $12,882.50 |
- 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
- $1,479.11 / $1,995.26 / $3,890.45
| Professional | | $1,479.11 | $1,995.26 | $3,890.45 |