- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $5,623.41
| Facility | | $1,000.00 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $3,090.30
| Professional | | $870.96 | $1,047.13 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $7,244.36
| Facility | | $56.23 | $2,398.83 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $7,079.46
| Professional | | $758.58 | $1,445.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,819.70 / $3,467.37
| Professional | | $1,023.29 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,479.11 / $8,511.38
| Facility | | $302.00 | $1,479.11 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,023.29 / $1,513.56
| Professional | | $524.81 | $1,023.29 | $1,513.56 |
- 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
- $912.01 / $1,621.81 / $2,344.23
| Professional | | $912.01 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,398.83 / $7,244.36
| Facility | | $56.23 | $2,398.83 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,412.54 / $7,079.46
| Professional | | $758.58 | $1,412.54 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,479.11 / $2,754.23
| Professional | | $1,023.29 | $1,479.11 | $2,754.23 |