- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,888.44 / $10,964.78
| Facility | | $1,071.52 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $954.99 / $3,235.94
| Professional | | $741.31 | $954.99 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,413.10 / $9,332.54
| Facility | | $6,606.93 | $7,413.10 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,174.90 / $1,659.59
| Professional | | $776.25 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $4,466.84 / $6,918.31
| Professional | | $794.33 | $4,466.84 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,584.89
| Professional | | $741.31 | $1,000.00 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $1,047.13
| Professional | | $691.83 | $812.83 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,380.38
| Professional | | $1,000.00 | $1,148.15 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,023.29 / $1,659.59
| Facility | | $741.31 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $8,709.64
| Facility | | $691.83 | $1,071.52 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $8,709.64
| Professional | | $691.83 | $1,071.52 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,479.11
| Professional | | $602.56 | $831.76 | $1,479.11 |