- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $5,623.41
| Facility | | $1,778.28 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,995.26 / $5,495.41
| Professional | | $1,584.89 | $1,995.26 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,244.36
| Facility | | $56.23 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $12,882.50
| Professional | | $1,479.11 | $2,630.27 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,235.94 / $6,165.95
| Professional | | $1,819.70 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,511.89 / $8,511.38
| Facility | | $302.00 | $2,511.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,819.70 / $2,691.53
| Professional | | $933.25 | $1,819.70 | $2,691.53 |
- 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
- $1,621.81 / $2,818.38 / $4,168.69
| Professional | | $1,621.81 | $2,818.38 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,244.36
| Facility | | $56.23 | $3,467.37 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,630.27 / $12,882.50
| Professional | | $1,479.11 | $2,630.27 | $12,882.50 |
- 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
- $1,819.70 / $2,754.23 / $5,128.61
| Professional | | $1,819.70 | $2,754.23 | $5,128.61 |