- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.63 / $2,075.54 / $3,655.04
| Facility | | $910.63 | $2,075.54 | $3,655.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.85 / $783.22 / $1,109.56
| Professional | | $691.85 | $783.22 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $201.36 / $1,174.83
| Professional | | $0.03 | $201.36 | $1,174.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.49 / $1,832.74 / $4,559.27
| Facility | | $848.49 | $1,832.74 | $4,559.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.72 / $6,291.88 / $6,291.88
| Professional | | $1,443.72 | $6,291.88 | $6,291.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $1,696.98 / $2,937.08
| Facility | | $319.00 | $1,696.98 | $2,937.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.76 / $1,710.03 / $2,832.65
| Professional | | $913.76 | $1,710.03 | $2,832.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.57 / $1,289.23 / $2,367.02
| Professional | | $1,109.57 | $1,289.23 | $2,367.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.94 / $1,832.74 / $4,699.82
| Facility | | $593.94 | $1,832.74 | $4,699.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.49 / $1,422.85 / $3,002.35
| Professional | | $848.49 | $1,422.85 | $3,002.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,978.39
| Professional | | $548.26 | $783.22 | $1,978.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.36 / $1,501.14 / $1,501.14
| Facility | | $1,305.36 | $1,501.14 | $1,501.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,109.57 / $1,305.36 / $1,568.95
| Professional | | $1,109.57 | $1,305.36 | $1,568.95 |