- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,388.44 / $5,623.41
| Facility | | $1,698.24 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,235.94 / $6,606.93
| Professional | | $1,737.80 | $3,235.94 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $8,317.64
| Facility | | $56.23 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,467.37 / $18,197.01
| Professional | | $1,862.09 | $3,467.37 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,248.07 / $9,332.54
| Professional | | $3,311.31 | $5,248.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,630.78 / $8,511.38
| Facility | | $302.00 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,388.44 / $4,677.35
| Professional | | $2,818.38 | $3,388.44 | $4,677.35 |
- 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
- $2,511.89 / $3,548.13 / $6,760.83
| Professional | | $2,511.89 | $3,548.13 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $8,317.64
| Facility | | $56.23 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,467.37 / $18,197.01
| Professional | | $1,862.09 | $3,467.37 | $18,197.01 |
- 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
- $1,949.84 / $3,715.35 / $7,762.47
| Professional | | $1,949.84 | $3,715.35 | $7,762.47 |