- 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 / $1,698.24 / $5,248.07
| Professional | | $831.76 | $1,698.24 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,090.30 / $7,244.36
| Facility | | $56.23 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,905.46 / $11,481.54
| Professional | | $1,023.29 | $1,905.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,754.23 / $4,897.79
| Professional | | $1,737.80 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,041.74 / $8,511.38
| Facility | | $302.00 | $2,041.74 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $2,818.38
| Professional | | $1,513.56 | $1,819.70 | $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
- $1,348.96 / $1,905.46 / $3,548.13
| Professional | | $1,348.96 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,090.30 / $7,244.36
| Facility | | $56.23 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,905.46 / $11,481.54
| Professional | | $1,023.29 | $1,905.46 | $11,481.54 |
- 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
- $1,548.82 / $2,041.74 / $4,168.69
| Professional | | $1,548.82 | $2,041.74 | $4,168.69 |