- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,388.44 / $5,623.41
| Facility | | $977.24 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,819.70 / $5,011.87
| Professional | | $1,318.26 | $1,819.70 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,311.31 / $7,244.36
| Facility | | $56.23 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,290.87 / $14,791.08
| Professional | | $1,122.02 | $2,290.87 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,090.30 / $5,248.07
| Professional | | $1,862.09 | $3,090.30 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,137.96 / $8,511.38
| Facility | | $302.00 | $2,137.96 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $3,467.37
| Professional | | $1,548.82 | $1,905.46 | $3,467.37 |
- 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
- $1,412.54 / $2,089.30 / $3,715.35
| Professional | | $1,412.54 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,311.31 / $7,244.36
| Facility | | $56.23 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,290.87 / $14,791.08
| Professional | | $1,122.02 | $2,290.87 | $14,791.08 |
- 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
- $1,659.59 / $2,454.71 / $4,570.88
| Professional | | $1,659.59 | $2,454.71 | $4,570.88 |