- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,388.44 / $5,623.41
| Facility | | $1,023.29 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,905.46 / $5,888.44
| Professional | | $1,023.29 | $1,905.46 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $7,244.36
| Facility | | $56.23 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,290.87 / $19,952.62
| Professional | | $1,174.90 | $2,290.87 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,162.28 / $5,495.41
| Professional | | $1,949.84 | $3,162.28 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,398.83 / $8,511.38
| Facility | | $1,445.44 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,041.74 / $3,388.44
| Professional | | $1,698.24 | $2,041.74 | $3,388.44 |
- 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
- $1,513.56 / $2,187.76 / $3,981.07
| Professional | | $1,513.56 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $7,244.36
| Facility | | $56.23 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,290.87 / $19,952.62
| Professional | | $1,174.90 | $2,290.87 | $19,952.62 |
- 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
- $1,778.28 / $2,511.89 / $4,677.35
| Professional | | $1,778.28 | $2,511.89 | $4,677.35 |