- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,388.44 / $4,786.30
| Facility | | $1,071.52 | $3,388.44 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $1,479.11
| Professional | | $1,000.00 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,073.80 / $7,244.36
| Facility | | $1,659.59 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $5,754.40
| Professional | | $912.01 | $1,513.56 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,174.90 / $2,454.71
| Facility | | $1,023.29 | $1,174.90 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,570.40
| Professional | | $2,187.76 | $2,187.76 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $2,454.71
| Professional | | $1,513.56 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,073.80 / $7,244.36
| Facility | | $1,659.59 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $5,754.40
| Professional | | $912.01 | $1,513.56 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,513.56 / $1,819.70
| Facility | | $912.01 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,174.90 / $2,630.27
| Professional | | $912.01 | $1,174.90 | $2,630.27 |