- 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 / $1,174.90 / $4,073.80
| Professional | | $741.31 | $1,174.90 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $8,709.64
| Facility | | $56.23 | $4,265.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,479.11 / $7,413.10
| Professional | | $707.95 | $1,479.11 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $3,388.44
| Professional | | $1,202.26 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,412.54 / $8,511.38
| Facility | | $302.00 | $1,412.54 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $2,290.87
| Professional | | $1,000.00 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $2,951.21
| Professional | | $912.01 | $1,584.89 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $8,709.64
| Facility | | $56.23 | $4,570.88 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,479.11 / $7,413.10
| Professional | | $707.95 | $1,479.11 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,471.29
| Facility | | $2,041.74 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,467.37
| Professional | | $1,071.52 | $1,659.59 | $3,467.37 |