- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,388.44 / $5,623.41
| Facility | | $1,071.52 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,754.23
| Professional | | $912.01 | $1,122.02 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $5,888.44
| Facility | | $56.23 | $2,344.23 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,513.56 / $10,715.19
| Professional | | $870.96 | $1,513.56 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,584.89 / $2,570.40
| Professional | | $954.99 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,862.09 / $7,079.46
| Facility | | $707.95 | $1,862.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $1,698.24
| Professional | | $977.24 | $1,230.27 | $1,698.24 |
- 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
- $891.25 / $1,584.89 / $2,398.83
| Professional | | $891.25 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $5,888.44
| Facility | | $56.23 | $2,454.71 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,513.56 / $10,715.19
| Professional | | $870.96 | $1,513.56 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,884.03 / $4,677.35
| Facility | | $977.24 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,513.56 / $2,754.23
| Professional | | $977.24 | $1,513.56 | $2,754.23 |