- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,073.80 / $8,317.64
| Facility | | $1,096.48 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $7,762.47
| Professional | | $1,202.26 | $1,698.24 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Professional | | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,165.95 / $57,543.99
| Facility | | $5,011.87 | $6,165.95 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $2,630.27
| Professional | | $1,258.93 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,187.76 / $2,398.83
| Professional | | $1,698.24 | $2,187.76 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $2,818.38
| Professional | | $1,258.93 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,317.64 / $12,882.50
| Facility | | $5,495.41 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,630.78 / $8,317.64
| Facility | | $1,023.29 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $4,897.79
| Professional | | $1,202.26 | $1,778.28 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,380.38 / $1,548.82
| Facility | | $467.74 | $1,380.38 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,380.38 / $1,548.82
| Professional | | $467.74 | $1,380.38 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $10,964.78
| Facility | | $2,089.30 | $3,981.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,884.03
| Professional | | $1,174.90 | $1,584.89 | $2,884.03 |