- 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 / $1,621.81 / $5,370.32
| Professional | | $1,023.29 | $1,621.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $11,481.54
| Professional | | $977.24 | $1,862.09 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,754.23 / $4,677.35
| Professional | | $1,659.59 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,949.84 / $8,511.38
| Facility | | $302.00 | $1,949.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,698.24 / $3,019.95
| Professional | | $1,380.38 | $1,698.24 | $3,019.95 |
- 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
- $1,230.27 / $1,737.80 / $3,311.31
| Professional | | $1,230.27 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,951.21 / $7,244.36
| Facility | | $56.23 | $2,951.21 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $11,481.54
| Professional | | $977.24 | $1,862.09 | $11,481.54 |
- 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
- $1,445.44 / $2,041.74 / $3,981.07
| Professional | | $1,445.44 | $2,041.74 | $3,981.07 |