- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,388.44 / $5,623.41
| Facility | | $1,096.48 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,454.71 / $3,019.95
| Professional | | $1,096.48 | $2,454.71 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $10,471.29
| Facility | | $56.23 | $2,754.23 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,073.80 / $10,000.00
| Professional | | $2,454.71 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,365.16 / $7,762.47
| Professional | | $2,630.27 | $4,365.16 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,786.30 / $8,511.38
| Facility | | $302.00 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,570.88 / $6,606.93
| Professional | | $3,801.89 | $4,570.88 | $6,606.93 |
- 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
- $2,951.21 / $3,981.07 / $7,762.47
| Professional | | $2,951.21 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $10,471.29
| Facility | | $56.23 | $2,754.23 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,073.80 / $10,000.00
| Professional | | $2,454.71 | $4,073.80 | $10,000.00 |
- 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 / $4,365.16 / $8,912.51
| Professional | | $1,995.26 | $4,365.16 | $8,912.51 |