- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $5,623.41
| Facility | | $2,691.53 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $7,585.78
| Professional | | $2,630.27 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $28,840.32
| Facility | | $56.23 | $2,454.71 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,168.69 / $20,417.38
| Professional | | $2,630.27 | $4,168.69 | $20,417.38 |
- 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
- $676.08 / $3,801.89 / $7,762.47
| Professional | | $676.08 | $3,801.89 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,801.89 / $8,511.38
| Facility | | $302.00 | $3,801.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,801.89 / $5,623.41
| Professional | | $2,754.23 | $3,801.89 | $5,623.41 |
- 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
- $2,754.23 / $4,897.79 / $7,244.36
| Professional | | $2,754.23 | $4,897.79 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $28,840.32
| Facility | | $56.23 | $2,454.71 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,168.69 / $20,417.38
| Professional | | $2,691.53 | $4,168.69 | $20,417.38 |
- 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
- $2,754.23 / $4,073.80 / $8,128.31
| Professional | | $2,754.23 | $4,073.80 | $8,128.31 |