- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $5,623.41
| Facility | | $2,187.76 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,238.72 / $6,165.95
| Professional | | $1,949.84 | $2,238.72 | $6,165.95 |
- 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
- $1,819.70 / $3,162.28 / $16,982.44
| Professional | | $1,819.70 | $3,162.28 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,981.07 / $6,760.83
| Professional | | $1,995.26 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,235.94 / $8,511.38
| Facility | | $302.00 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $4,265.80
| Professional | | $2,344.23 | $2,951.21 | $4,265.80 |
- 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
- $2,137.96 / $3,801.89 / $5,623.41
| Professional | | $2,137.96 | $3,801.89 | $5,623.41 |
- 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
- $1,819.70 / $3,090.30 / $16,982.44
| Professional | | $1,819.70 | $3,090.30 | $16,982.44 |
- 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
- $2,344.23 / $3,311.31 / $6,606.93
| Professional | | $2,344.23 | $3,311.31 | $6,606.93 |