- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $6,606.93 / $13,489.63
| Facility | | $549.54 | $6,606.93 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $1,548.82
| Professional | | $281.84 | $446.68 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,165.95 / $12,022.64
| Facility | | $4,677.35 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $467.74 / $630.96
| Professional | | $275.42 | $467.74 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $660.69 / $933.25
| Professional | | $338.84 | $660.69 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $1,995.26
| Facility | | $295.12 | $489.78 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $645.65 / $3,090.30
| Professional | | $302.00 | $645.65 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $933.25
| Professional | | $630.96 | $741.31 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $954.99
| Professional | | $630.96 | $741.31 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $8,128.31
| Facility | | $1,995.26 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $537.03 / $794.33
| Professional | | $323.59 | $537.03 | $794.33 |