- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,905.46 / $7,943.28
| Facility | | $1,445.44 | $1,905.46 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,995.26
| Professional | | $660.69 | $812.83 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,318.26 / $1,995.26
| Professional | | $741.31 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $1,778.28
| Professional | | $1,122.02 | $1,479.11 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $1,778.28
| Facility | | $707.95 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $1,862.09
| Professional | | $1,096.48 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,380.38 / $1,479.11
| Facility | | $1,023.29 | $1,380.38 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,584.89
| Facility | | $707.95 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,348.96 / $1,949.84
| Professional | | $79.43 | $1,348.96 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,011.87 / $6,165.95
| Facility | | $3,801.89 | $5,011.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,137.96
| Professional | | $1,258.93 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $8,128.31 / $12,882.50
| Facility | | $1,995.26 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $1,949.84
| Professional | | $933.25 | $1,380.38 | $1,949.84 |