- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,218.59 / $1,955.93 / $3,973.92
| Facility | | $1,218.59 | $1,955.93 | $3,973.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.96 / $1,043.16 / $1,238.75
| Professional | | $977.96 | $1,043.16 | $1,238.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $1,475.73 / $10,028.28
| Facility | | $59.40 | $1,475.73 | $10,028.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,525.62 / $1,825.53 / $2,307.98
| Facility | | $1,525.62 | $1,825.53 | $2,307.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.21 / $1,978.60 / $4,980.55
| Facility | | $490.21 | $1,978.60 | $4,980.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $362.15 / $1,316.99
| Professional | | $335.33 | $362.15 | $1,316.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $1,303.95
| Professional | | $1,303.95 | $1,303.95 | $1,303.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,303.95 / $1,303.95 / $1,982.00
| Professional | | $1,303.95 | $1,303.95 | $1,982.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.29 / $847.57 / $2,130.71
| Professional | | $593.29 | $847.57 | $2,130.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.37 / $782.37 / $977.20
| Professional | | $782.37 | $782.37 | $977.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.46 / $2,135.88 / $3,788.64
| Facility | | $1,059.46 | $2,135.88 | $3,788.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.35 / $1,588.27 / $1,902.92
| Professional | | $1,513.35 | $1,588.27 | $1,902.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.18 / $1,006.18 / $1,341.58
| Facility | | $1,006.18 | $1,006.18 | $1,341.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $670.79 / $1,533.58
| Professional | | $469.55 | $670.79 | $1,533.58 |