- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,429.50 / $5,280.94 / $10,135.60
| Facility | | $3,429.50 | $5,280.94 | $10,135.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,843.33 / $3,410.56 / $4,192.47
| Professional | | $2,843.33 | $3,410.56 | $4,192.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,385.00 / $10,311.04 / $14,433.40
| Facility | | $6,385.00 | $10,311.04 | $14,433.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,722.03 / $3,546.83 / $4,963.71
| Professional | | $2,722.03 | $3,546.83 | $4,963.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,347.22 / $3,364.81 / $6,561.38
| Professional | | $3,347.22 | $3,364.81 | $6,561.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $610.00 / $3,447.56
| Facility | | $490.00 | $610.00 | $3,447.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,677.42 / $3,556.42 / $6,419.22
| Professional | | $1,677.42 | $3,556.42 | $6,419.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,775.96 / $3,429.13 / $4,954.84
| Professional | | $2,775.96 | $3,429.13 | $4,954.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,276.61 / $3,674.06 / $5,629.03
| Facility | | $2,276.61 | $3,674.06 | $5,629.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,415.65 / $4,213.00 / $6,946.13
| Professional | | $3,415.65 | $4,213.00 | $6,946.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.28 / $3,567.79 / $6,484.90
| Facility | | $1,790.28 | $3,567.79 | $6,484.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.28 / $3,567.79 / $6,484.90
| Professional | | $1,790.28 | $3,567.79 | $6,484.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.00 / $2,397.00 / $5,202.00
| Facility | | $327.00 | $2,397.00 | $5,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.93 / $3,200.47 / $5,874.69
| Professional | | $1,936.93 | $3,200.47 | $5,874.69 |