- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,388.44 / $8,511.38
| Facility | | $1,258.93 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $6,918.31
| Professional | | $1,258.93 | $2,041.74 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $7,244.36
| Facility | | $56.23 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,398.83 / $5,888.44
| Professional | | $1,174.90 | $2,398.83 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,467.37 / $5,495.41
| Professional | | $1,949.84 | $3,467.37 | $5,495.41 |
- 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 / $3,715.35
| Professional | | $1,621.81 | $1,949.84 | $3,715.35 |
- 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 / $2,187.76 / $3,801.89
| Professional | | $1,445.44 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,388.44 / $7,244.36
| Facility | | $56.23 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,398.83 / $5,888.44
| Professional | | $1,174.90 | $2,398.83 | $5,888.44 |
- 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
- $1,862.09 / $2,884.03 / $4,786.30
| Professional | | $1,862.09 | $2,884.03 | $4,786.30 |