- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.36 / $4,241.22 / $13,841.56
| Facility | | $990.36 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.18 / $772.13 / $2,052.35
| Professional | | $295.18 | $772.13 | $2,052.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.21 / $723.21 / $1,396.24
| Professional | | $723.21 | $723.21 | $1,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.32 / $492.33 / $952.33
| Facility | | $374.32 | $492.33 | $952.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.57 / $612.38 / $1,192.22
| Professional | | $310.57 | $612.38 | $1,192.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.69 / $982.39 / $1,787.50
| Professional | | $615.69 | $982.39 | $1,787.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.26 / $863.84 / $1,478.96
| Facility | | $430.26 | $863.84 | $1,478.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.03 / $1,316.16 / $2,418.02
| Professional | | $738.03 | $1,316.16 | $2,418.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.51 / $929.99 / $1,608.13
| Facility | | $574.51 | $929.99 | $1,608.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.87 / $1,127.23 / $1,655.81
| Professional | | $692.87 | $1,127.23 | $1,655.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.16 / $642.62 / $1,289.32
| Professional | | $334.16 | $642.62 | $1,289.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.03 / $1,259.33 / $1,502.95
| Professional | | $738.03 | $1,259.33 | $1,502.95 |