- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,623.41
| Facility | | $2,691.53 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,168.69 / $10,232.93
| Professional | | $3,548.13 | $4,168.69 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $8,709.64 / $40,738.03
| Facility | | $56.23 | $8,709.64 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $30,199.52
| Professional | | $3,630.78 | $6,165.95 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $6,025.60 / $10,715.19
| Professional | | $3,801.89 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,897.79 / $8,511.38
| Facility | | $302.00 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,786.30 / $6,760.83
| Professional | | $3,801.89 | $4,786.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $20,417.38
| Facility | | $2,691.53 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,456.54 / $9,549.93
| Professional | | $3,548.13 | $6,456.54 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $8,709.64 / $40,738.03
| Facility | | $56.23 | $8,709.64 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $30,199.52
| Professional | | $3,630.78 | $6,165.95 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $7,244.36 / $33,884.42
| Facility | | $2,951.21 | $7,244.36 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,025.60 / $10,715.19
| Professional | | $4,168.69 | $6,025.60 | $10,715.19 |