- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,388.44 / $5,623.41
| Facility | | $1,318.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,995.26 / $5,128.61
| Professional | | $1,548.82 | $1,995.26 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,244.36
| Facility | | $56.23 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,570.40 / $12,302.69
| Professional | | $1,479.11 | $2,570.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,311.31 / $6,309.57
| Professional | | $1,778.28 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,630.27 / $8,511.38
| Facility | | $302.00 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $3,890.45
| Professional | | $1,905.46 | $2,344.23 | $3,890.45 |
- 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
- $1,698.24 / $3,019.95 / $4,466.84
| Professional | | $1,698.24 | $3,019.95 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,244.36
| Facility | | $56.23 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,570.40 / $12,302.69
| Professional | | $1,479.11 | $2,570.40 | $12,302.69 |
- 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
- $1,995.26 / $2,754.23 / $5,011.87
| Professional | | $1,995.26 | $2,754.23 | $5,011.87 |