- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $5,623.41
| Facility | | $2,290.87 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,344.23 / $7,244.36
| Professional | | $2,041.74 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,413.10
| Facility | | $56.23 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,311.31 / $16,218.10
| Professional | | $1,905.46 | $3,311.31 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,365.16 / $6,918.31
| Professional | | $2,089.30 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,311.31 / $8,511.38
| Facility | | $302.00 | $3,311.31 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,019.95 / $4,570.88
| Professional | | $2,454.71 | $3,019.95 | $4,570.88 |
- 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
- $2,238.72 / $3,981.07 / $5,888.44
| Professional | | $2,238.72 | $3,981.07 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $7,413.10
| Facility | | $56.23 | $3,467.37 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $16,218.10
| Professional | | $1,905.46 | $3,235.94 | $16,218.10 |
- 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
- $2,511.89 / $3,467.37 / $6,760.83
| Professional | | $2,511.89 | $3,467.37 | $6,760.83 |