- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $3,162.28
| Facility | | $1,230.27 | $1,949.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,412.54
| Professional | | $776.25 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $1,584.89
| Professional | | $338.84 | $389.05 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $18,197.01 / $41,686.94
| Facility | | $1,202.26 | $18,197.01 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $20,417.38 / $36,307.81
| Professional | | $1,621.81 | $20,417.38 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $2,754.23
| Facility | | $851.14 | $851.14 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $1,659.59
| Professional | | $891.25 | $1,513.56 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,348.96 / $4,570.88
| Facility | | $851.14 | $1,348.96 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $2,570.40
| Professional | | $977.24 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,174.90 / $1,318.26
| Facility | | $467.74 | $1,174.90 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,479.11
| Professional | | $467.74 | $676.08 | $1,479.11 |