- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,715.35 / $6,456.54
| Facility | | $1,288.25 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $3,715.35
| Professional | | $724.44 | $977.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $8,317.64 / $25,703.96
| Facility | | $1,995.26 | $8,317.64 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $3,715.35
| Professional | | $724.44 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,570.40 / $2,630.27
| Professional | | $1,380.38 | $2,570.40 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $2,754.23
| Professional | | $851.14 | $1,479.11 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,584.89 / $7,079.46
| Facility | | $741.31 | $1,584.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $1,258.93
| Professional | | $446.68 | $851.14 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $2,344.23
| Professional | | $891.25 | $1,445.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $8,709.64 / $25,703.96
| Facility | | $2,041.74 | $8,709.64 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $3,715.35
| Professional | | $724.44 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $19,054.61
| Facility | | $2,570.40 | $7,244.36 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,348.96 / $3,162.28
| Professional | | $912.01 | $1,348.96 | $3,162.28 |