- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.83 / $1,958.05 / $3,585.84
| Facility | | $1,174.83 | $1,958.05 | $3,585.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.76 / $1,044.30 / $1,135.67
| Professional | | $913.76 | $1,044.30 | $1,135.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.86 / $1,915.63 / $5,090.93
| Facility | | $422.86 | $1,915.63 | $5,090.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,527.28 / $1,827.51 / $2,310.50
| Facility | | $1,527.28 | $1,827.51 | $2,310.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.29 / $1,914.68 / $3,179.09
| Facility | | $656.29 | $1,914.68 | $3,179.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $943.78 / $3,681.14
| Facility | | $92.60 | $943.78 | $3,681.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.22 / $783.22 / $1,109.56
| Professional | | $783.22 | $783.22 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $691.85 / $1,827.52
| Professional | | $5.00 | $691.85 | $1,827.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $223.50 / $1,016.88
| Professional | | $201.36 | $223.50 | $1,016.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.94 / $848.49 / $2,121.65
| Professional | | $593.94 | $848.49 | $2,121.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.01 / $2,024.90 / $4,006.45
| Facility | | $933.01 | $2,024.90 | $4,006.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.72 / $1,566.44 / $1,729.74
| Professional | | $1,443.72 | $1,566.44 | $1,729.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.09 / $1,240.09 / $1,566.44
| Facility | | $1,240.09 | $1,240.09 | $1,566.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,696.98
| Professional | | $548.26 | $783.22 | $1,696.98 |