- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,548.82 / $2,137.96
| Facility | | $478.63 | $1,548.82 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $660.69
| Professional | | $457.09 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $3,311.31
| Facility | | $758.58 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $2,570.40
| Professional | | $416.87 | $691.83 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $537.03 / $1,096.48
| Facility | | $457.09 | $537.03 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,000.00
| Professional | | $831.76 | $831.76 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,174.90
| Professional | | $1,000.00 | $1,000.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,479.11
| Professional | | $691.83 | $691.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,862.09 / $3,311.31
| Facility | | $758.58 | $1,862.09 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $2,570.40
| Professional | | $416.87 | $691.83 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $831.76
| Facility | | $416.87 | $691.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $691.83 / $1,412.54
| Professional | | $416.87 | $691.83 | $1,412.54 |