- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.29 / $1,955.41 / $5,375.30
| Facility | | $561.29 | $1,955.41 | $5,375.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.87 / $621.16 / $636.13
| Professional | | $407.87 | $621.16 | $636.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $3,749.43
| Facility | | $244.00 | $614.00 | $3,749.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $382.27 / $627.05
| Professional | | $335.33 | $382.27 | $627.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.52 / $486.45 / $1,216.36
| Professional | | $340.52 | $486.45 | $1,216.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.75 / $1,255.04 / $2,505.21
| Facility | | $493.75 | $1,255.04 | $2,505.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.39 / $898.07 / $1,197.42
| Professional | | $748.39 | $898.07 | $1,197.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.55 / $860.65 / $1,429.42
| Professional | | $673.55 | $860.65 | $1,429.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.20 / $3,554.85 / $3,554.85
| Facility | | $1,302.20 | $3,554.85 | $3,554.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,726.98 / $3,726.98 / $5,612.93
| Professional | | $3,726.98 | $3,726.98 | $5,612.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.71 / $898.07 / $1,985.69
| Facility | | $598.71 | $898.07 | $1,985.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.39 / $823.23 / $1,122.58
| Professional | | $748.39 | $823.23 | $1,122.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.32 / $327.02 / $1,802.05
| Professional | | $314.32 | $327.02 | $1,802.05 |