- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.32 / $1,048.16 / $1,471.90
| Facility | | $804.32 | $1,048.16 | $1,471.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $976.84 / $1,302.45
| Professional | | $29.46 | $976.84 | $1,302.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,459.92 / $8,639.91 / $79,506.39
| Facility | | $8,459.92 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.65 / $1,196.15 / $1,973.55
| Professional | | $1,152.65 | $1,196.15 | $1,973.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.61 / $46.61 / $46.61
| Facility | | $46.61 | $46.61 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.06 / $76.06 / $76.06
| Facility | | $76.06 | $76.06 | $76.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,423.87 / $1,842.10 / $2,429.04
| Professional | | $1,423.87 | $1,842.10 | $2,429.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.70 / $1,304.59 / $1,323.14
| Professional | | $34.70 | $1,304.59 | $1,323.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.32 / $1,048.16 / $1,471.90
| Facility | | $804.32 | $1,048.16 | $1,471.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.85 / $1,021.01 / $1,476.75
| Professional | | $29.85 | $1,021.01 | $1,476.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.46 / $1,232.97 / $2,465.94
| Professional | | $35.46 | $1,232.97 | $2,465.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.61 / $46.61 / $46.61
| Facility | | $46.61 | $46.61 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.65 / $1,103.36 / $1,145.44
| Facility | | $27.65 | $1,103.36 | $1,145.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.36 / $1,079.49 / $1,212.46
| Professional | | $33.36 | $1,079.49 | $1,212.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.59 / $1,197.51 / $1,989.96
| Professional | | $939.59 | $1,197.51 | $1,989.96 |