- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,388.44 / $5,623.41
| Facility | | $1,230.27 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $3,715.35
| Professional | | $1,096.48 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $7,244.36
| Facility | | $56.23 | $2,754.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $9,549.93
| Professional | | $933.25 | $1,737.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,238.72 / $4,168.69
| Professional | | $1,230.27 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,778.28 / $8,511.38
| Facility | | $302.00 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,258.93 / $1,862.09
| Professional | | $645.65 | $1,258.93 | $1,862.09 |
- 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
- $1,096.48 / $1,949.84 / $2,884.03
| Professional | | $1,096.48 | $1,949.84 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $7,244.36
| Facility | | $56.23 | $2,754.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,698.24 / $9,549.93
| Professional | | $933.25 | $1,698.24 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,388.44
| Professional | | $1,202.26 | $1,778.28 | $3,388.44 |