- 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
- $575.44 / $707.95 / $1,905.46
| Professional | | $575.44 | $707.95 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,570.88 / $33,884.42
| Facility | | $1,174.90 | $4,570.88 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $5,011.87
| Professional | | $588.84 | $1,047.13 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $2,137.96
| Professional | | $1,445.44 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,047.13 / $1,862.09
| Professional | | $575.44 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,548.82 / $7,079.46
| Facility | | $707.95 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $977.24 / $1,348.96
| Professional | | $794.33 | $977.24 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,318.26 / $2,089.30
| Professional | | $707.95 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $33,884.42
| Facility | | $1,548.82 | $4,570.88 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $5,011.87
| Professional | | $588.84 | $1,047.13 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $10,715.19
| Facility | | $1,584.89 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,047.13 / $2,089.30
| Professional | | $660.69 | $1,047.13 | $2,089.30 |