- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $5,623.41
| Facility | | $2,691.53 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $8,317.64
| Professional | | $2,511.89 | $2,951.21 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $10,000.00
| Facility | | $56.23 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,168.69 / $20,892.96
| Professional | | $2,290.87 | $4,168.69 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $8,317.64
| Professional | | $2,818.38 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,630.78 / $8,511.38
| Facility | | $302.00 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,548.13 / $5,754.40
| Professional | | $2,818.38 | $3,548.13 | $5,754.40 |
- 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
- $2,570.40 / $4,570.88 / $6,760.83
| Professional | | $2,570.40 | $4,570.88 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,467.37 / $10,000.00
| Facility | | $56.23 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,981.07 / $20,892.96
| Professional | | $2,290.87 | $3,981.07 | $20,892.96 |
- 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
- $3,019.95 / $4,168.69 / $8,511.38
| Professional | | $3,019.95 | $4,168.69 | $8,511.38 |