- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $5,011.87 / $8,317.64
| Facility | | $758.58 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,445.44
| Professional | | $588.84 | $707.95 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,698.24
| Professional | | $660.69 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,174.90
| Professional | | $676.08 | $831.76 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $812.83 / $1,445.44
| Professional | | $630.96 | $812.83 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $933.25
| Professional | | $616.60 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $1,548.82
| Professional | | $912.01 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,348.96
| Facility | | $630.96 | $870.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Professional | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $9,549.93
| Facility | | $602.56 | $831.76 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $9,549.93
| Professional | | $602.56 | $831.76 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,220.18 / $23,988.33
| Facility | | $6,456.54 | $11,220.18 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,348.96
| Professional | | $501.19 | $776.25 | $1,348.96 |