- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $6,165.95
| Facility | | $1,584.89 | $3,630.78 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,445.44 / $3,388.44
| Professional | | $1,122.02 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,981.07 / $11,748.98
| Facility | | $56.23 | $3,981.07 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,621.81 / $9,549.93
| Professional | | $977.24 | $1,621.81 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $3,019.95
| Professional | | $1,318.26 | $2,290.87 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $3,715.35
| Professional | | $1,071.52 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,995.26 / $7,585.78
| Facility | | $977.24 | $1,995.26 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $1,862.09
| Professional | | $1,071.52 | $1,348.96 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $13,182.57
| Facility | | $2,344.23 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $3,162.28
| Professional | | $1,047.13 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,187.76 / $5,248.07
| Facility | | $2,041.74 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,737.80 / $1,819.70
| Professional | | $1,659.59 | $1,737.80 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,897.79 / $12,589.25
| Facility | | $56.23 | $4,897.79 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,621.81 / $9,549.93
| Professional | | $977.24 | $1,621.81 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $13,182.57
| Facility | | $2,344.23 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,235.94
| Professional | | $1,148.15 | $1,621.81 | $3,235.94 |