- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $5,011.87
| Facility | | $1,122.02 | $1,122.02 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $1,819.70
| Professional | | $812.83 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Professional | 50 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,912.51 / $20,417.38
| Facility | | $5,011.87 | $8,912.51 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,912.51 / $15,848.93 / $40,738.03
| Facility | 50 | $8,912.51 | $15,848.93 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $3,630.78
| Professional | | $1,548.82 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,290.87 / $3,311.31 / $5,248.07
| Professional | 50 | $2,290.87 | $3,311.31 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,890.45 / $9,332.54
| Facility | | $2,754.23 | $3,890.45 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,951.21 / $4,786.30
| Professional | | $1,778.28 | $2,951.21 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $7,244.36
| Facility | | $2,951.21 | $3,715.35 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,570.40 / $4,168.69
| Professional | | $1,862.09 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $6,918.31
| Facility | | $1,096.48 | $1,862.09 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $4,265.80
| Professional | | $977.24 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Professional | 50 | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,715.19
| Facility | | $3,019.95 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,737.80 / $3,630.78
| Professional | | $1,023.29 | $1,737.80 | $3,630.78 |