- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $794.33
| Professional | | $354.81 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $13,182.57
| Facility | | $2,137.96 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $5,370.32
| Professional | | $416.87 | $676.08 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $8,511.38
| Facility | | $933.25 | $1,513.56 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,258.93 / $1,778.28
| Professional | | $1,047.13 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,513.56 / $2,691.53
| Professional | | $870.96 | $1,513.56 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,248.07 / $13,182.57
| Facility | | $2,398.83 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $5,370.32
| Professional | | $416.87 | $676.08 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $15,135.61
| Facility | | $2,041.74 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $2,570.40
| Professional | | $436.52 | $851.14 | $2,570.40 |