- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,388.44 / $5,623.41
| Facility | | $1,258.93 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,398.83 / $8,511.38
| Professional | | $1,698.24 | $2,398.83 | $8,511.38 |
- 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
- $1,445.44 / $2,818.38 / $19,054.61
| Professional | | $1,445.44 | $2,818.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Professional | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,981.07 / $6,918.31
| Professional | | $2,454.71 | $3,981.07 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,818.38 / $8,511.38
| Facility | | $302.00 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $4,265.80
| Professional | | $2,089.30 | $2,511.89 | $4,265.80 |
- 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
- $1,862.09 / $2,630.27 / $4,897.79
| Professional | | $1,862.09 | $2,630.27 | $4,897.79 |
- 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
- $1,445.44 / $2,818.38 / $19,054.61
| Professional | | $1,445.44 | $2,818.38 | $19,054.61 |
- 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
- $2,187.76 / $3,019.95 / $5,623.41
| Professional | | $2,187.76 | $3,019.95 | $5,623.41 |