- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.78 / $4,953.45 / $8,555.95
| Facility | | $2,551.78 | $4,953.45 | $8,555.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.00 / $2,440.82 / $2,500.00
| Professional | | $1,500.00 | $2,440.82 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $3,062.13 / $6,634.63
| Professional | | $0.03 | $3,062.13 | $6,634.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.09 / $3,002.09 / $3,002.09
| Facility | | $3,002.09 | $3,002.09 | $3,002.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,002.09 / $3,002.09 / $3,002.09
| Professional | | $3,002.09 | $3,002.09 | $3,002.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,985.58 / $6,079.77 / $7,790.59
| Facility | | $2,985.58 | $6,079.77 | $7,790.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.67 / $4,381.22 / $14,470.07
| Professional | | $2,401.67 | $4,381.22 | $14,470.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $3,602.51 / $6,754.70
| Facility | | $294.00 | $3,602.51 | $6,754.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,152.19 / $3,962.76 / $6,514.54
| Professional | | $3,152.19 | $3,962.76 | $6,514.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.78 / $2,964.97 / $5,443.67
| Professional | | $2,551.78 | $2,964.97 | $5,443.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,927.04 / $7,325.02 / $7,790.59
| Facility | | $2,927.04 | $7,325.02 | $7,790.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.36 / $3,752.61 / $6,904.81
| Professional | | $1,951.36 | $3,752.61 | $6,904.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.88 / $1,801.25 / $4,653.24
| Professional | | $1,260.88 | $1,801.25 | $4,653.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,002.09 / $3,452.33 / $3,452.33
| Facility | | $3,002.09 | $3,452.33 | $3,452.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,551.78 / $3,002.09 / $3,608.26
| Professional | | $2,551.78 | $3,002.09 | $3,608.26 |