- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,388.44 / $5,623.41
| Facility | | $1,412.54 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $3,981.07
| Professional | | $1,380.38 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $12,022.64
| Facility | | $56.23 | $2,089.30 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,187.76 / $10,964.78
| Professional | | $1,380.38 | $2,187.76 | $10,964.78 |
- 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
- $512.86 / $1,995.26 / $4,168.69
| Professional | | $512.86 | $1,995.26 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,344.23 / $8,511.38
| Facility | | $302.00 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $3,019.95
| Professional | | $1,513.56 | $2,089.30 | $3,019.95 |
- 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
- $1,513.56 / $2,630.27 / $3,981.07
| Professional | | $1,513.56 | $2,630.27 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,089.30 / $12,022.64
| Facility | | $56.23 | $2,089.30 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,187.76 / $10,964.78
| Professional | | $1,380.38 | $2,187.76 | $10,964.78 |
- 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
- $1,412.54 / $2,137.96 / $4,365.16
| Professional | | $1,412.54 | $2,137.96 | $4,365.16 |