- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $8,511.38
| Facility | | $1,737.80 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,949.84 / $4,677.35
| Professional | | $1,659.59 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $24,547.09
| Facility | | $56.23 | $1,862.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $13,182.57
| Professional | | $1,659.59 | $2,630.27 | $13,182.57 |
- 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
- $933.25 / $2,344.23 / $4,786.30
| Professional | | $933.25 | $2,344.23 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,691.53 / $8,511.38
| Facility | | $302.00 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,398.83 / $3,467.37
| Professional | | $1,737.80 | $2,398.83 | $3,467.37 |
- 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
- $1,737.80 / $3,090.30 / $4,570.88
| Professional | | $1,737.80 | $3,090.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $24,547.09
| Facility | | $56.23 | $1,862.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,570.40 / $13,182.57
| Professional | | $1,659.59 | $2,570.40 | $13,182.57 |
- 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
- $1,698.24 / $2,511.89 / $5,128.61
| Professional | | $1,698.24 | $2,511.89 | $5,128.61 |