- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.48 / $4,568.79 / $5,391.18
| Facility | | $1,723.48 | $4,568.79 | $5,391.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.71 / $1,031.24 / $1,109.56
| Professional | | $856.71 | $1,031.24 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.19 / $1,018.19 / $1,018.19
| Professional | | $1,018.19 | $1,018.19 | $1,018.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.94 / $1,695.96 / $4,332.29
| Facility | | $873.94 | $1,695.96 | $4,332.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,500.02 / $1,875.02
| Professional | | $1,500.02 | $1,500.02 | $1,875.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.47 / $770.17 / $1,767.47
| Professional | | $600.47 | $770.17 | $1,767.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.96 / $5,391.18 / $5,391.18
| Facility | | $2,008.96 | $5,391.18 | $5,391.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.71 / $1,057.34 / $5,391.18
| Professional | | $856.71 | $1,057.34 | $5,391.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.94 / $1,649.64 / $4,332.29
| Facility | | $873.94 | $1,649.64 | $4,332.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,500.02 / $1,875.02
| Professional | | $1,500.02 | $1,500.02 | $1,875.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,305.36 / $1,435.91
| Facility | | $1,305.36 | $1,305.36 | $1,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.73 / $1,305.36 / $1,435.91
| Professional | | $1,148.73 | $1,305.36 | $1,435.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $2,219.13
| Professional | | $548.26 | $783.22 | $2,219.13 |