- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,630.78 / $6,918.31
| Facility | | $1,513.56 | $3,630.78 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,096.48 / $3,467.37
| Professional | | $851.14 | $1,096.48 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,897.79 / $16,595.87
| Facility | | $1,905.46 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $9,772.37
| Professional | | $891.25 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,862.09 / $2,570.40
| Professional | | $1,659.59 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $6,456.54
| Facility | | $954.99 | $1,047.13 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,230.27 / $2,511.89
| Professional | | $512.86 | $1,230.27 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,862.09 / $7,079.46
| Facility | | $812.83 | $1,862.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $1,862.09
| Professional | | $891.25 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,584.89 / $2,398.83
| Professional | | $891.25 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,897.79 / $16,595.87
| Facility | | $1,905.46 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $9,772.37
| Professional | | $891.25 | $1,445.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $13,182.57
| Facility | | $1,584.89 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $2,630.27
| Professional | | $891.25 | $1,348.96 | $2,630.27 |