- 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
- $1,000.00 / $1,202.26 / $3,235.94
| Professional | | $1,000.00 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $16,218.10
| Facility | | $56.23 | $4,265.80 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $8,317.64
| Professional | | $977.24 | $1,659.59 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $3,801.89
| Professional | | $1,096.48 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,659.59 / $8,511.38
| Facility | | $302.00 | $1,659.59 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,148.15 / $1,737.80
| Professional | | $602.56 | $1,148.15 | $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
- $1,174.90 / $1,949.84 / $3,162.28
| Professional | | $1,174.90 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $16,218.10
| Facility | | $56.23 | $4,265.80 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $8,317.64
| Professional | | $977.24 | $1,659.59 | $8,317.64 |
- 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
- $1,230.27 / $1,819.70 / $4,265.80
| Professional | | $1,230.27 | $1,819.70 | $4,265.80 |