- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,388.44 / $5,623.41
| Facility | | $1,148.15 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,995.26 / $7,079.46
| Professional | | $1,148.15 | $1,995.26 | $7,079.46 |
- 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
- $1,202.26 / $2,511.89 / $11,220.18
| Professional | | $1,202.26 | $2,511.89 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,388.44 / $5,623.41
| Professional | | $1,995.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,290.87 / $8,511.38
| Facility | | $302.00 | $2,290.87 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,801.89
| Professional | | $1,659.59 | $2,041.74 | $3,801.89 |
- 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 / $2,238.72 / $4,073.80
| Professional | | $1,513.56 | $2,238.72 | $4,073.80 |
- 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
- $1,202.26 / $2,511.89 / $11,220.18
| Professional | | $1,202.26 | $2,511.89 | $11,220.18 |
- 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 / $2,630.27 / $4,897.79
| Professional | | $1,778.28 | $2,630.27 | $4,897.79 |