- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,388.44 / $5,623.41
| Facility | | $954.99 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,778.28 / $5,754.40
| Professional | | $954.99 | $1,778.28 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,311.31 / $7,244.36
| Facility | | $56.23 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,089.30 / $10,000.00
| Professional | | $1,096.48 | $2,089.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,951.21 / $5,248.07
| Professional | | $1,862.09 | $2,951.21 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,187.76 / $8,511.38
| Facility | | $302.00 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $3,162.28
| Professional | | $1,621.81 | $1,949.84 | $3,162.28 |
- 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
- $1,445.44 / $2,041.74 / $3,801.89
| Professional | | $1,445.44 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,311.31 / $7,244.36
| Facility | | $56.23 | $3,311.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,089.30 / $10,000.00
| Professional | | $1,096.48 | $2,089.30 | $10,000.00 |
- 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
- $1,659.59 / $2,290.87 / $4,466.84
| Professional | | $1,659.59 | $2,290.87 | $4,466.84 |