- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.48 / $6,732.07 / $19,276.96
| Facility | | $543.48 | $6,732.07 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.36 / $543.48 / $2,197.78
| Professional | | $398.36 | $543.48 | $2,197.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.57 / $186.57 / $186.57
| Professional | | $186.57 | $186.57 | $186.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.42 / $776.92 / $1,112.53
| Professional | | $425.42 | $776.92 | $1,112.53 |
- 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
- $621.66 / $1,141.66 / $1,696.49
| Professional | | $621.66 | $1,141.66 | $1,696.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.11 / $756.90 / $2,028.88
| Facility | | $474.11 | $756.90 | $2,028.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.74 / $1,219.36 / $3,232.96
| Professional | | $730.74 | $1,219.36 | $3,232.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.40 / $1,301.47 / $2,842.49
| Facility | | $916.40 | $1,301.47 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.33 / $1,128.38 / $1,562.49
| Professional | | $843.33 | $1,128.38 | $1,562.49 |
- 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
- $730.74 / $1,208.54 / $1,573.91
| Professional | | $730.74 | $1,208.54 | $1,573.91 |