- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,388.44 / $5,623.41
| Facility | | $1,148.15 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $3,162.28
| Professional | | $1,096.48 | $1,288.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $10,964.78
| Facility | | $56.23 | $2,089.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,698.24 / $8,709.64
| Professional | | $1,096.48 | $1,698.24 | $8,709.64 |
- 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 / $1,584.89 / $3,311.31
| Professional | | $588.84 | $1,584.89 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $8,511.38
| Facility | | $302.00 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $2,344.23
| Professional | | $1,174.90 | $1,621.81 | $2,344.23 |
- 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
- $1,174.90 / $2,041.74 / $3,090.30
| Professional | | $1,174.90 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $10,964.78
| Facility | | $56.23 | $2,089.30 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,698.24 / $8,709.64
| Professional | | $1,096.48 | $1,698.24 | $8,709.64 |
- 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
- $1,122.02 / $1,698.24 / $3,388.44
| Professional | | $1,122.02 | $1,698.24 | $3,388.44 |