- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,388.44 / $5,623.41
| Facility | | $870.96 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,584.89 / $4,365.16
| Professional | | $1,148.15 | $1,584.89 | $4,365.16 |
- 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 / $1,995.26 / $10,471.29
| Professional | | $977.24 | $1,995.26 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,691.53 / $4,570.88
| Professional | | $1,621.81 | $2,691.53 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $8,511.38
| Facility | | $302.00 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $2,951.21
| Professional | | $1,318.26 | $1,621.81 | $2,951.21 |
- 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
- $1,202.26 / $1,778.28 / $3,162.28
| Professional | | $1,202.26 | $1,778.28 | $3,162.28 |
- 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 / $1,995.26 / $10,471.29
| Professional | | $977.24 | $1,995.26 | $10,471.29 |
- 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
- $1,445.44 / $2,089.30 / $3,981.07
| Professional | | $1,445.44 | $2,089.30 | $3,981.07 |