- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,388.44 / $5,623.41
| Facility | | $831.76 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $5,128.61
| Professional | | $831.76 | $1,513.56 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $7,244.36
| Facility | | $56.23 | $2,884.03 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $10,715.19
| Professional | | $977.24 | $1,905.46 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $4,570.88
| Professional | | $1,621.81 | $2,630.27 | $4,570.88 |
- 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
- $1,412.54 / $1,698.24 / $2,818.38
| Professional | | $1,412.54 | $1,698.24 | $2,818.38 |
- 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
- $1,258.93 / $1,778.28 / $3,311.31
| Professional | | $1,258.93 | $1,778.28 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $7,244.36
| Facility | | $56.23 | $2,884.03 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $10,715.19
| Professional | | $977.24 | $1,905.46 | $10,715.19 |
- 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 / $2,041.74 / $3,890.45
| Professional | | $1,479.11 | $2,041.74 | $3,890.45 |