- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $5,623.41
| Facility | | $2,290.87 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $12,589.25
| Professional | | $2,290.87 | $4,265.80 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $10,471.29
| Facility | | $56.23 | $3,467.37 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,248.07 / $13,803.84
| Professional | | $2,630.27 | $5,248.07 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $12,302.69
| Professional | | $4,365.16 | $7,079.46 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,570.88 / $8,511.38
| Facility | | $302.00 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $7,943.28
| Professional | | $3,715.35 | $4,466.84 | $7,943.28 |
- 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
- $3,311.31 / $4,786.30 / $8,709.64
| Professional | | $3,311.31 | $4,786.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $10,964.78
| Facility | | $56.23 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,248.07 / $13,803.84
| Professional | | $2,630.27 | $5,248.07 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $4,677.35
| Facility | | $1,000.00 | $3,311.31 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,754.40 / $10,715.19
| Professional | | $3,890.45 | $5,754.40 | $10,715.19 |