- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,388.44 / $5,623.41
| Facility | | $1,621.81 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $5,495.41
| Professional | | $1,621.81 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,370.32 / $15,135.61
| Facility | | $56.23 | $5,370.32 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,754.23 / $14,125.38
| Professional | | $1,479.11 | $2,754.23 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,630.78 / $7,079.46
| Professional | | $1,737.80 | $3,630.78 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $8,511.38
| Facility | | $1,659.59 | $2,630.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,398.83 / $4,168.69
| Professional | | $1,905.46 | $2,398.83 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,162.28 / $5,128.61
| Professional | | $1,737.80 | $3,162.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,888.44 / $15,135.61
| Facility | | $56.23 | $5,888.44 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,754.23 / $14,125.38
| Professional | | $1,479.11 | $2,754.23 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,090.30 / $6,456.54
| Professional | | $1,995.26 | $3,090.30 | $6,456.54 |