- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,041.74 / $7,943.28
| Facility | | $1,096.48 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $2,511.89
| Professional | | $812.83 | $1,096.48 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $2,454.71
| Professional | | $1,096.48 | $1,737.80 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,737.80 / $2,137.96
| Professional | | $831.76 | $1,737.80 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $2,344.23
| Facility | | $1,096.48 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,584.89 / $2,511.89
| Professional | | $1,380.38 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $1,659.59
| Facility | | $1,288.25 | $1,584.89 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,041.74
| Facility | | $1,047.13 | $1,380.38 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,548.82 / $2,290.87
| Professional | | $79.43 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,949.84 / $2,630.27
| Professional | | $1,513.56 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,698.24 / $2,454.71
| Professional | | $1,096.48 | $1,698.24 | $2,454.71 |