- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,884.03 / $4,265.80
| Facility | | $1,230.27 | $2,884.03 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,698.24
| Professional | | $912.01 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $2,238.72
| Professional | | $239.88 | $239.88 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,137.96 / $5,495.41
| Facility | | $977.24 | $2,137.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $7,244.36
| Professional | | $1,513.56 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $5,888.44
| Facility | | $1,513.56 | $2,511.89 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $2,951.21
| Professional | | $1,584.89 | $2,041.74 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,479.11 / $2,691.53
| Professional | | $1,288.25 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $50,118.72
| Facility | | $1,995.26 | $2,884.03 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,548.82
| Professional | | $1,513.56 | $1,513.56 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,513.56 / $1,819.70
| Facility | | $1,380.38 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $1,995.26
| Professional | | $630.96 | $912.01 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $1,737.80
| Facility | | $1,288.25 | $1,513.56 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,513.56 / $3,019.95
| Professional | | $1,023.29 | $1,513.56 | $3,019.95 |