- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,344.23 / $8,511.38
| Facility | | $575.44 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $2,290.87
| Professional | | $758.58 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,445.44
| Professional | | $724.44 | $977.24 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,365.16 / $8,511.38
| Facility | | $3,311.31 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $1,862.09
| Professional | | $812.83 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,238.72 / $2,951.21
| Professional | | $831.76 | $2,238.72 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,621.81 / $3,715.35
| Facility | | $891.25 | $1,621.81 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $7,413.10
| Professional | | $1,202.26 | $2,041.74 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $2,884.03
| Professional | | $1,862.09 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,238.72 / $2,570.40
| Professional | | $1,862.09 | $2,238.72 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $8,128.31
| Facility | | $2,570.40 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,737.80 / $2,344.23
| Professional | | $1,023.29 | $1,737.80 | $2,344.23 |