- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $5,128.61
| Facility | | $1,230.27 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,230.27 / $2,630.27
| Professional | | $338.84 | $1,230.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,011.87 / $9,332.54
| Facility | | $56.23 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,000.00 / $3,801.89
| Professional | | $346.74 | $1,000.00 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $870.96
| Facility | | $371.54 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,513.56 / $3,630.78
| Professional | | $478.63 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $478.63 / $7,079.46
| Facility | | $177.83 | $478.63 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $3,388.44
| Professional | | $1,479.11 | $1,778.28 | $3,388.44 |
- 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
- $371.54 / $1,230.27 / $3,162.28
| Professional | | $371.54 | $1,230.27 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,248.07 / $9,332.54
| Facility | | $56.23 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $1,000.00 / $3,801.89
| Professional | | $346.74 | $1,000.00 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $10,471.29
| Facility | | $2,137.96 | $5,248.07 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,445.44 / $3,801.89
| Professional | | $446.68 | $1,445.44 | $3,801.89 |