- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,388.44 / $5,623.41
| Facility | | $1,258.93 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $3,890.45
| Professional | | $1,096.48 | $1,318.26 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,818.38 / $7,244.36
| Facility | | $56.23 | $2,818.38 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,778.28 / $9,772.37
| Professional | | $954.99 | $1,778.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $4,265.80
| Professional | | $1,258.93 | $2,290.87 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,819.70 / $8,511.38
| Facility | | $302.00 | $1,819.70 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,288.25 / $1,905.46
| Professional | | $660.69 | $1,288.25 | $1,905.46 |
- 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
- $1,122.02 / $1,995.26 / $2,951.21
| Professional | | $1,122.02 | $1,995.26 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,818.38 / $7,244.36
| Facility | | $56.23 | $2,818.38 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,778.28 / $9,772.37
| Professional | | $954.99 | $1,778.28 | $9,772.37 |
- 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 / $1,819.70 / $3,467.37
| Professional | | $1,230.27 | $1,819.70 | $3,467.37 |