- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,090.30 / $8,317.64
| Facility | | $616.60 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $1,023.29
| Professional | | $389.05 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,570.40 / $4,897.79
| Facility | | $1,737.80 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $831.76
| Professional | | $691.83 | $794.33 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $724.44
| Professional | | $416.87 | $575.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $3,090.30
| Facility | | $407.38 | $707.95 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $758.58 / $1,023.29
| Professional | | $537.03 | $758.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,890.45 / $5,248.07
| Facility | | $2,951.21 | $3,890.45 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $891.25
| Professional | | $575.44 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $4,073.80
| Professional | | $371.54 | $489.78 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $12,302.69
| Facility | | $1,348.96 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $870.96
| Professional | | $446.68 | $616.60 | $870.96 |