- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,388.44 / $5,623.41
| Facility | | $1,995.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $5,888.44
| Professional | | $1,995.26 | $2,454.71 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $20,892.96
| Facility | | $56.23 | $2,454.71 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,235.94 / $16,218.10
| Professional | | $2,041.74 | $3,235.94 | $16,218.10 |
- 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 / $2,884.03 / $6,165.95
| Professional | | $588.84 | $2,884.03 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,311.31 / $8,511.38
| Facility | | $302.00 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,162.28 / $4,466.84
| Professional | | $2,290.87 | $3,162.28 | $4,466.84 |
- 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
- $2,238.72 / $3,981.07 / $5,888.44
| Professional | | $2,238.72 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $20,892.96
| Facility | | $56.23 | $2,454.71 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,162.28 / $16,218.10
| Professional | | $2,089.30 | $3,162.28 | $16,218.10 |
- 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
- $2,089.30 / $3,162.28 / $6,606.93
| Professional | | $2,089.30 | $3,162.28 | $6,606.93 |