- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $4,265.80 / $7,762.47
| Facility | | $724.44 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,318.26 / $4,168.69
| Professional | | $912.01 | $1,318.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $7,244.36
| Facility | | $56.23 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,621.81 / $3,801.89
| Professional | | $758.58 | $1,621.81 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $2,818.38
| Professional | | $1,348.96 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,513.56 / $8,511.38
| Facility | | $302.00 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,288.25 / $2,398.83
| Professional | | $1,071.52 | $1,288.25 | $2,398.83 |
- 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
- $954.99 / $1,445.44 / $2,570.40
| Professional | | $954.99 | $1,445.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Facility | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $7,244.36
| Facility | | $56.23 | $2,454.71 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,621.81 / $3,801.89
| Professional | | $758.58 | $1,621.81 | $3,801.89 |
- 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
- $1,202.26 / $1,862.09 / $3,311.31
| Professional | | $1,202.26 | $1,862.09 | $3,311.31 |