- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.51 / $3,772.57 / $8,373.50
| Facility | | $917.51 | $3,772.57 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.60 / $909.52 / $956.38
| Professional | | $577.60 | $909.52 | $956.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.46 / $1,720.69 / $3,006.86
| Facility | | $1,390.46 | $1,720.69 | $3,006.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,028.70 / $5,745.10 / $7,422.51
| Facility | | $4,028.70 | $5,745.10 | $7,422.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,419.55 / $7,336.00 / $13,801.00
| Facility | | $4,419.55 | $7,336.00 | $13,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.90 / $100.00 / $5,835.42
| Facility | | $66.90 | $100.00 | $5,835.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.87 / $1,042.66 / $1,696.57
| Professional | | $865.87 | $1,042.66 | $1,696.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.66 / $846.65 / $1,886.51
| Professional | | $592.66 | $846.65 | $1,886.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.28 / $828.24 / $1,165.45
| Professional | | $610.28 | $828.24 | $1,165.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,421.50 / $2,292.26 / $3,385.20
| Facility | | $1,421.50 | $2,292.26 | $3,385.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.82 / $1,279.82 / $1,532.18
| Professional | | $696.82 | $1,279.82 | $1,532.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,562.00 / $6,526.00 / $11,543.00
| Facility | | $2,562.00 | $6,526.00 | $11,543.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $842.47 / $1,198.22 / $2,226.64
| Professional | | $842.47 | $1,198.22 | $2,226.64 |