- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,454.71 / $7,943.28
| Facility | | $1,318.26 | $2,454.71 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,288.25 / $3,019.95
| Professional | | $691.83 | $1,288.25 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,089.30 / $2,951.21
| Professional | | $1,348.96 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,089.30 / $2,570.40
| Professional | | $977.24 | $2,089.30 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $2,884.03
| Facility | | $1,318.26 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $2,951.21
| Professional | | $1,621.81 | $1,905.46 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,905.46 / $2,089.30
| Facility | | $1,659.59 | $1,905.46 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $2,570.40
| Facility | | $1,230.27 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,862.09 / $2,754.23
| Professional | | $79.43 | $1,862.09 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $3,162.28
| Professional | | $1,862.09 | $2,398.83 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $25,703.96 / $52,480.75
| Facility | | $3,311.31 | $25,703.96 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $2,951.21
| Professional | | $1,380.38 | $2,137.96 | $2,951.21 |