- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $7,943.28
| Facility | | $1,071.52 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $2,454.71
| Professional | | $831.76 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $2,398.83
| Professional | | $1,096.48 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,698.24 / $2,041.74
| Professional | | $758.58 | $1,698.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,398.83
| Facility | | $1,071.52 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,454.71
| Professional | | $1,318.26 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,548.82 / $1,659.59
| Facility | | $1,348.96 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,089.30
| Facility | | $954.99 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,513.56 / $2,238.72
| Professional | | $79.43 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,949.84 / $2,570.40
| Professional | | $1,513.56 | $1,949.84 | $2,570.40 |
- 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
- $1,122.02 / $1,737.80 / $2,398.83
| Professional | | $1,122.02 | $1,737.80 | $2,398.83 |