- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,388.44 / $5,623.41
| Facility | | $1,258.93 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $3,630.78
| Professional | | $1,258.93 | $1,445.44 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $28,840.32
| Facility | | $56.23 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $10,000.00
| Professional | | $1,258.93 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,137.96 / $3,801.89
| Professional | | $1,412.54 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,041.74 / $8,511.38
| Facility | | $302.00 | $2,041.74 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $2,454.71
| Professional | | $1,380.38 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,290.87 / $3,467.37
| Professional | | $1,288.25 | $2,290.87 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,677.35 / $28,840.32
| Facility | | $56.23 | $4,677.35 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $10,000.00
| Professional | | $1,258.93 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $20,892.96
| Facility | | $2,570.40 | $7,244.36 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $3,801.89
| Professional | | $1,380.38 | $2,041.74 | $3,801.89 |