- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $5,128.61
| Facility | | $1,778.28 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $2,691.53
| Professional | | $851.14 | $1,023.29 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,011.87 / $16,595.87
| Facility | | $56.23 | $5,011.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $7,585.78
| Professional | | $933.25 | $1,380.38 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $2,754.23
| Professional | | $1,023.29 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,513.56 / $8,511.38
| Facility | | $302.00 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $1,737.80
| Professional | | $933.25 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,659.59 / $2,818.38
| Professional | | $933.25 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,011.87 / $16,595.87
| Facility | | $56.23 | $5,011.87 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,380.38 / $7,585.78
| Professional | | $870.96 | $1,380.38 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $2,818.38
| Professional | | $1,023.29 | $1,380.38 | $2,818.38 |