- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,388.44 / $5,623.41
| Facility | | $1,621.81 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $4,466.84
| Professional | | $1,445.44 | $1,778.28 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,715.35 / $5,888.44
| Facility | | $1,737.80 | $3,715.35 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $11,220.18
| Professional | | $1,348.96 | $2,344.23 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,398.83 / $4,168.69
| Professional | | $1,548.82 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,630.27 / $7,079.46
| Facility | | $707.95 | $2,630.27 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $2,951.21
| Professional | | $1,698.24 | $2,137.96 | $2,951.21 |
- 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
- $1,621.81 / $2,884.03 / $4,265.80
| Professional | | $1,621.81 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,715.35 / $5,888.44
| Facility | | $1,778.28 | $3,715.35 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $11,220.18
| Professional | | $1,348.96 | $2,344.23 | $11,220.18 |
- 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
- $1,513.56 / $2,344.23 / $4,677.35
| Professional | | $1,513.56 | $2,344.23 | $4,677.35 |