- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.90 / $6,358.44 / $11,440.30
| Facility | | $1,050.90 | $6,358.44 | $11,440.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.90 / $1,050.90 / $1,084.44
| Professional | | $1,050.90 | $1,050.90 | $1,084.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.15 / $2,790.32 / $6,103.83
| Facility | | $1,831.15 | $2,790.32 | $6,103.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $3,565.72 / $13,079.63
| Professional | | $1,569.56 | $3,565.72 | $13,079.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.71 / $3,707.11 / $4,503.10
| Facility | | $1,813.71 | $3,707.11 | $4,503.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.56 / $1,743.95 / $4,359.88
| Facility | | $1,569.56 | $1,743.95 | $4,359.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $1,743.95 / $4,359.88
| Professional | | $1,569.56 | $1,743.95 | $4,359.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Professional | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.56 / $1,918.35 / $3,051.91
| Facility | | $1,569.56 | $1,918.35 | $3,051.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.95 / $3,051.91 / $5,231.85
| Facility | | $1,743.95 | $3,051.91 | $5,231.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $2,179.94 / $3,226.31
| Professional | | $1,569.56 | $2,179.94 | $3,226.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.15 / $2,790.32 / $4,795.85
| Facility | | $1,831.15 | $2,790.32 | $4,795.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.81 / $2,933.22 / $4,054.99
| Professional | | $1,928.81 | $2,933.22 | $4,054.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $469.55 / $1,953.22
| Professional | | $469.55 | $469.55 | $1,953.22 |