- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $6,309.57 / $10,964.78
| Facility | | $831.76 | $6,309.57 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $776.25 / $1,905.46
| Professional | | $371.54 | $776.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $524.81 / $891.25
| Professional | | $223.87 | $524.81 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $6,165.95
| Facility | | $2,398.83 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $977.24
| Professional | | $398.11 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $954.99 / $1,479.11
| Professional | | $446.68 | $954.99 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $891.25 / $6,309.57
| Facility | | $467.74 | $891.25 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $954.99 / $3,801.89
| Professional | | $616.60 | $954.99 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,148.15 / $1,412.54
| Professional | | $933.25 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,122.02
| Professional | | $891.25 | $891.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $602.56 / $1,348.96
| Professional | | $3.02 | $602.56 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,495.41 / $8,128.31
| Facility | | $3,630.78 | $5,495.41 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $812.83 / $1,174.90
| Professional | | $549.54 | $812.83 | $1,174.90 |