- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $6,165.95 / $15,488.17
| Facility | | $1,000.00 | $6,165.95 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,621.81
| Professional | | $758.58 | $933.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,218.10 / $21,877.62
| Facility | | $8,709.64 | $16,218.10 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $1,659.59
| Professional | | $870.96 | $1,174.90 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $1,513.56
| Professional | | $933.25 | $1,174.90 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $1,905.46
| Professional | | $812.83 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $2,454.71
| Professional | | $776.25 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,513.56 / $2,137.96
| Professional | | $1,202.26 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $1,862.09
| Facility | | $812.83 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $5,248.07
| Facility | | $851.14 | $1,202.26 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $5,248.07
| Professional | | $851.14 | $1,202.26 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $7,079.46
| Facility | | $1,698.24 | $3,467.37 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $1,862.09
| Professional | | $741.31 | $1,148.15 | $1,862.09 |