- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $8,709.64
| Facility | | $1,096.48 | $1,737.80 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $2,630.27
| Professional | | $1,000.00 | $1,174.90 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $3,019.95
| Professional | | $1,148.15 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $2,691.53
| Professional | | $1,148.15 | $1,513.56 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,570.40
| Professional | | $1,737.80 | $1,737.80 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,187.76
| Facility | | $1,096.48 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,949.84 / $2,398.83
| Professional | | $1,548.82 | $1,949.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,202.26 / $2,344.23
| Professional | | $933.25 | $1,202.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $12,882.50 / $12,882.50
| Facility | | $56.23 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $9,772.37
| Professional | | $8,128.31 | $8,128.31 | $9,772.37 |