- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,466.84 / $10,964.78
| Facility | | $776.25 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $933.25
| Professional | | $245.47 | $407.38 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,025.60 / $11,748.98
| Facility | | $4,570.88 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $741.31
| Professional | | $302.00 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,122.02
| Professional | | $426.58 | $741.31 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $1,995.26
| Facility | | $323.59 | $489.78 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $2,884.03
| Professional | | $446.68 | $758.58 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $1,174.90
| Professional | | $575.44 | $812.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,174.90
| Professional | | $588.84 | $812.83 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,162.28 / $8,128.31
| Facility | | $2,041.74 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $537.03 / $933.25
| Professional | | $309.03 | $537.03 | $933.25 |