- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,388.44 / $5,623.41
| Facility | | $2,041.74 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $5,495.41
| Professional | | $1,949.84 | $2,290.87 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $19,054.61
| Facility | | $56.23 | $2,344.23 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $14,791.08
| Professional | | $1,778.28 | $3,019.95 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $741.31 / $1,380.38
| Facility | | $50.12 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,754.23 / $5,623.41
| Professional | | $588.84 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,090.30 / $8,511.38
| Facility | | $302.00 | $3,090.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,818.38 / $4,073.80
| Professional | | $2,041.74 | $2,818.38 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,548.13 / $5,370.32
| Professional | | $1,995.26 | $3,548.13 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $19,054.61
| Facility | | $56.23 | $2,344.23 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,019.95 / $14,791.08
| Professional | | $1,778.28 | $3,019.95 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $5,888.44
| Professional | | $1,862.09 | $2,951.21 | $5,888.44 |