- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $8,709.64
| Facility | | $1,445.44 | $2,238.72 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $3,630.78
| Professional | | $1,318.26 | $1,659.59 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $3,630.78
| Professional | | $1,412.54 | $1,995.26 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $3,467.37
| Professional | | $1,348.96 | $1,905.46 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Professional | | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,737.80 / $2,818.38
| Facility | | $1,348.96 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $2,754.23 / $3,715.35
| Professional | | $6.03 | $2,754.23 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,548.82 / $2,884.03
| Professional | | $1,202.26 | $1,548.82 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $11,481.54 / $11,481.54
| Facility | | $56.23 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $12,589.25
| Professional | | $10,471.29 | $10,471.29 | $12,589.25 |