- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,388.44 / $5,623.41
| Facility | | $1,905.46 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $5,754.40
| Professional | | $1,778.28 | $2,137.96 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,187.76 / $18,197.01
| Facility | | $56.23 | $2,187.76 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,818.38 / $14,125.38
| Professional | | $1,737.80 | $2,818.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $1,380.38
| Facility | | $50.12 | $676.08 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $2,630.27 / $5,370.32
| Professional | | $588.84 | $2,630.27 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,019.95 / $8,511.38
| Facility | | $302.00 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,754.23 / $3,981.07
| Professional | | $1,995.26 | $2,754.23 | $3,981.07 |
- 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
- $1,949.84 / $3,467.37 / $5,248.07
| Professional | | $1,949.84 | $3,467.37 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,187.76 / $18,197.01
| Facility | | $56.23 | $2,187.76 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,818.38 / $14,125.38
| Professional | | $1,737.80 | $2,818.38 | $14,125.38 |
- 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
- $1,778.28 / $2,754.23 / $5,754.40
| Professional | | $1,778.28 | $2,754.23 | $5,754.40 |