- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $2,511.89
| Professional | | $870.96 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,623.41 / $33,884.42
| Facility | | $1,949.84 | $5,623.41 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $7,079.46
| Professional | | $891.25 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,479.11 / $2,691.53
| Professional | | $933.25 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,905.46 / $7,079.46
| Facility | | $707.95 | $1,905.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,698.24
| Professional | | $977.24 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,698.24 / $2,754.23
| Professional | | $933.25 | $1,698.24 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $33,884.42
| Facility | | $2,137.96 | $5,623.41 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $7,079.46
| Professional | | $891.25 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $12,882.50
| Facility | | $2,511.89 | $5,888.44 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $2,754.23
| Professional | | $1,000.00 | $1,548.82 | $2,754.23 |