- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,238.72 / $7,762.47
| Facility | | $831.76 | $2,238.72 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $630.96 / $1,258.93
| Professional | | $549.54 | $630.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,621.81
| Professional | | $524.81 | $776.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,479.11
| Professional | | $616.60 | $831.76 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,412.54
| Professional | | $977.24 | $977.24 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $1,174.90
| Facility | | $602.56 | $776.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $1,318.26
| Professional | | $891.25 | $1,096.48 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,454.40
| Facility | | $2,454.71 | $9,332.54 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,288.25
| Professional | | $512.86 | $660.69 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $8,912.51 / $8,912.51
| Facility | | $56.23 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $5,370.32
| Professional | | $4,466.84 | $4,466.84 | $5,370.32 |