- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,388.44 / $5,623.41
| Facility | | $1,202.26 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,258.93 / $3,715.35
| Professional | | $1,071.52 | $1,258.93 | $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
- $912.01 / $1,737.80 / $9,120.11
| Professional | | $912.01 | $1,737.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,187.76 / $4,168.69
| Professional | | $1,230.27 | $2,187.76 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,737.80 / $8,511.38
| Facility | | $302.00 | $1,737.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,230.27 / $1,819.70
| Professional | | $630.96 | $1,230.27 | $1,819.70 |
- 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 / $2,818.38
| Professional | | $1,096.48 | $1,949.84 | $2,818.38 |
- 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
- $912.01 / $1,698.24 / $9,120.11
| Professional | | $912.01 | $1,698.24 | $9,120.11 |
- 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
- $1,230.27 / $1,778.28 / $3,311.31
| Professional | | $1,230.27 | $1,778.28 | $3,311.31 |