- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $2,454.71
| Professional | | $812.83 | $1,000.00 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $28,840.32
| Facility | | $56.23 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $6,456.54
| Professional | | $831.76 | $1,380.38 | $6,456.54 |
- 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
- $933.25 / $1,174.90 / $1,621.81
| Professional | | $933.25 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,513.56 / $2,290.87
| Professional | | $851.14 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $28,840.32
| Facility | | $56.23 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $6,456.54
| Professional | | $831.76 | $1,380.38 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $2,511.89
| Professional | | $912.01 | $1,380.38 | $2,511.89 |