- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.19 / $4,241.22 / $13,841.56
| Facility | | $511.19 | $4,241.22 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.99 / $511.19 / $1,747.83
| Professional | | $306.99 | $511.19 | $1,747.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.73 / $743.46 / $1,033.06
| Professional | | $736.73 | $743.46 | $1,033.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,949.61 / $3,879.54 / $7,504.28
| Facility | | $2,949.61 | $3,879.54 | $7,504.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.88 / $628.50 / $1,036.46
| Professional | | $326.88 | $628.50 | $1,036.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,062.42 / $1,062.42
| Facility | | $1,062.42 | $1,062.42 | $1,062.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.45 / $1,021.04 / $1,485.68
| Professional | | $594.45 | $1,021.04 | $1,485.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.21 / $638.99 / $1,741.55
| Facility | | $367.21 | $638.99 | $1,741.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.09 / $1,017.00 / $2,499.36
| Professional | | $646.09 | $1,017.00 | $2,499.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.66 / $1,126.79 / $1,485.68
| Facility | | $754.66 | $1,126.79 | $1,485.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.92 / $1,005.15 / $1,405.16
| Professional | | $668.92 | $1,005.15 | $1,405.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.37 / $1,103.32 / $1,325.12
| Professional | | $630.37 | $1,103.32 | $1,325.12 |