- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.29 / $4,778.89 / $13,841.56
| Facility | | $462.29 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.17 / $462.29 / $1,015.56
| Professional | | $287.17 | $462.29 | $1,015.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.87 / $341.87 / $341.87
| Professional | | $341.87 | $341.87 | $341.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,063.17 / $11,728.12
| Facility | | $4,609.82 | $6,063.17 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.43 / $584.13 / $936.00
| Professional | | $305.43 | $584.13 | $936.00 |
- 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
- $562.13 / $922.06 / $1,344.69
| Professional | | $562.13 | $922.06 | $1,344.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.44 / $574.34 / $1,492.04
| Facility | | $342.44 | $574.34 | $1,492.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.50 / $928.01 / $2,342.96
| Professional | | $586.50 | $928.01 | $2,342.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.07 / $1,062.42 / $1,425.21
| Facility | | $705.07 | $1,062.42 | $1,425.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.37 / $878.64 / $1,277.85
| Professional | | $633.37 | $878.64 | $1,277.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.37 / $928.01 / $1,209.18
| Professional | | $562.37 | $928.01 | $1,209.18 |