- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,623.41
| Facility | | $2,691.53 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,168.69 / $12,882.50
| Professional | | $3,630.78 | $4,168.69 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $13,182.57
| Facility | | $56.23 | $3,548.13 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $28,183.83
| Professional | | $3,235.94 | $5,888.44 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,413.10 / $12,589.25
| Professional | | $3,715.35 | $7,413.10 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $5,248.07 / $8,511.38
| Facility | | $302.00 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,370.32 / $7,762.47
| Professional | | $4,265.80 | $5,370.32 | $7,762.47 |
- 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
- $3,890.45 / $6,918.31 / $10,471.29
| Professional | | $3,890.45 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $13,182.57
| Facility | | $56.23 | $3,548.13 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $28,183.83
| Professional | | $3,235.94 | $5,754.40 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $4,677.35
| Facility | | $1,000.00 | $2,951.21 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,165.95 / $12,022.64
| Professional | | $3,981.07 | $6,165.95 | $12,022.64 |