- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $2,454.71
| Professional | | $707.95 | $831.76 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,265.80 / $10,964.78
| Facility | | $56.23 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $7,943.28
| Professional | | $707.95 | $1,202.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,348.96 / $2,691.53
| Professional | | $831.76 | $1,348.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,548.82 / $7,079.46
| Facility | | $741.31 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $831.76 / $1,258.93
| Professional | | $436.52 | $831.76 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $2,290.87
| Professional | | $831.76 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $10,964.78
| Facility | | $56.23 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $7,943.28
| Professional | | $707.95 | $1,202.26 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $12,022.64
| Facility | | $2,041.74 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $3,162.28
| Professional | | $891.25 | $1,288.25 | $3,162.28 |