- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,388.44 / $5,623.41
| Facility | | $912.01 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,698.24 / $5,011.87
| Professional | | $912.01 | $1,698.24 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $10,964.78
| Facility | | $56.23 | $3,388.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,949.84 / $10,000.00
| Professional | | $1,071.52 | $1,949.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,818.38 / $5,128.61
| Professional | | $1,905.46 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,089.30 / $8,511.38
| Facility | | $302.00 | $2,089.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,862.09 / $2,754.23
| Professional | | $1,548.82 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $3,630.78
| Professional | | $1,348.96 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $10,964.78
| Facility | | $56.23 | $3,388.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,949.84 / $10,000.00
| Professional | | $1,071.52 | $1,949.84 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,801.89 / $9,120.11
| Facility | | $1,288.25 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,041.74 / $4,265.80
| Professional | | $1,479.11 | $2,041.74 | $4,265.80 |