- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $5,495.41
| Facility | | $1,318.26 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $1,548.82
| Professional | | $776.25 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,623.41 / $13,489.63
| Facility | | $2,570.40 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $1,584.89
| Professional | | $1,318.26 | $1,548.82 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,479.11
| Professional | | $912.01 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,548.82 / $5,495.41
| Facility | | $933.25 | $1,548.82 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $1,548.82
| Professional | | $776.25 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $16,218.10
| Facility | | $8,511.38 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,258.93 / $1,513.56
| Professional | | $1,047.13 | $1,258.93 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,348.96 / $12,302.69
| Professional | | $645.65 | $1,348.96 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $25,118.86 / $38,904.51
| Facility | | $10,232.93 | $25,118.86 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,071.52 / $1,584.89
| Professional | | $776.25 | $1,071.52 | $1,584.89 |