- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,089.30 / $10,471.29
| Facility | | $851.14 | $2,089.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,778.28
| Professional | | $602.56 | $776.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $588.84
| Facility | | $575.44 | $575.44 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $3,630.78
| Professional | | $691.83 | $1,096.48 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $891.25 / $1,659.59
| Professional | | $630.96 | $891.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,819.70
| Professional | | $891.25 | $891.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,348.96
| Facility | | $630.96 | $851.14 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $1,659.59
| Professional | | $1,174.90 | $1,412.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,467.37 / $6,606.93
| Facility | | $1,122.02 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $1,412.54
| Professional | | $549.54 | $741.31 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $33,884.42
| Facility | | $4,365.16 | $4,365.16 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $6,456.54
| Professional | | $5,623.41 | $5,623.41 | $6,456.54 |