- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,265.80 / $7,762.47
| Facility | | $2,089.30 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,290.87
| Professional | | $1,096.48 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $13,489.63
| Facility | | $1,000.00 | $3,388.44 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $8,709.64
| Professional | | $1,737.80 | $2,884.03 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,848.93 / $21,877.62
| Facility | | $7,762.47 | $15,848.93 | $21,877.62 |
- 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
- $1,584.89 / $1,584.89 / $1,862.09
| Professional | | $1,584.89 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,819.70 / $2,884.03
| Professional | | $1,047.13 | $1,819.70 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $13,489.63
| Facility | | $1,023.29 | $3,467.37 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $8,709.64
| Professional | | $1,737.80 | $2,884.03 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $4,677.35
| Facility | | $1,000.00 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,570.40 / $4,073.80
| Professional | | $1,288.25 | $2,570.40 | $4,073.80 |