- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $5,011.87
| Facility | | $575.44 | $575.44 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $912.01
| Professional | | $501.19 | $588.84 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $14,791.08
| Facility | | $3,388.44 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $2,137.96
| Professional | | $933.25 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $5,011.87
| Facility | | $1,479.11 | $2,089.30 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $2,570.40
| Professional | | $1,023.29 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,041.74 / $3,890.45
| Facility | | $1,621.81 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $2,290.87
| Professional | | $1,096.48 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,122.02 / $9,332.54
| Facility | | $588.84 | $1,122.02 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $3,311.31
| Professional | | $537.03 | $1,096.48 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,317.64 / $12,882.50
| Facility | | $4,365.16 | $8,317.64 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,023.29 / $2,041.74
| Professional | | $562.34 | $1,023.29 | $2,041.74 |