- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.63 / $8,042.03 / $19,276.96
| Facility | | $353.63 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.32 / $462.50 / $1,344.55
| Professional | | $241.32 | $462.50 | $1,344.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.55 / $220.55 / $220.55
| Professional | | $220.55 | $220.55 | $220.55 |
- 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
- $253.74 / $476.56 / $716.23
| Professional | | $253.74 | $476.56 | $716.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.02 / $815.85 / $1,276.94
| Professional | | $503.02 | $815.85 | $1,276.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.64 / $583.49 / $1,757.70
| Facility | | $301.64 | $583.49 | $1,757.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.50 / $1,307.58 / $2,742.05
| Professional | | $819.50 | $1,307.58 | $2,742.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.98 / $1,178.00 / $2,842.49
| Facility | | $692.98 | $1,178.00 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.79 / $1,089.00 / $1,633.31
| Professional | | $643.79 | $1,089.00 | $1,633.31 |
- 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
- $850.13 / $1,307.58 / $1,877.57
| Professional | | $850.13 | $1,307.58 | $1,877.57 |