- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,884.03 / $4,265.80
| Facility | | $1,258.93 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,621.81
| Professional | | $912.01 | $1,202.26 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $1,778.28
| Professional | | $512.86 | $512.86 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,137.96 / $5,495.41
| Facility | | $1,000.00 | $2,137.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $7,413.10 / $7,413.10
| Professional | | $1,548.82 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,511.89 / $5,888.44
| Facility | | $1,548.82 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,905.46 / $2,951.21
| Professional | | $1,071.52 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,513.56 / $2,754.23
| Professional | | $1,318.26 | $1,513.56 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $50,118.72
| Facility | | $1,995.26 | $2,884.03 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,584.89
| Professional | | $1,548.82 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,548.82 / $1,862.09
| Facility | | $1,380.38 | $1,548.82 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $912.01 / $2,041.74
| Professional | | $645.65 | $912.01 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $1,778.28
| Facility | | $1,318.26 | $1,548.82 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $3,019.95
| Professional | | $1,047.13 | $1,548.82 | $3,019.95 |