- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,388.44 / $5,623.41
| Facility | | $2,570.40 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $7,079.46
| Professional | | $2,137.96 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $8,128.31
| Facility | | $56.23 | $3,467.37 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,715.35 / $17,378.01
| Professional | | $2,089.30 | $3,715.35 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Professional | | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,677.35 / $7,585.78
| Professional | | $2,187.76 | $4,677.35 | $7,585.78 |
- 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
- $2,398.83 / $3,019.95 / $5,370.32
| Professional | | $2,398.83 | $3,019.95 | $5,370.32 |
- 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 / $5,754.40
| Professional | | $2,137.96 | $3,801.89 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $8,128.31
| Facility | | $56.23 | $3,467.37 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,630.78 / $17,378.01
| Professional | | $2,089.30 | $3,630.78 | $17,378.01 |
- 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
- $2,570.40 / $3,801.89 / $7,079.46
| Professional | | $2,570.40 | $3,801.89 | $7,079.46 |