- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.38 / $4,518.60 / $13,841.56
| Facility | | $488.38 | $4,518.60 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.85 / $445.30 / $1,127.82
| Professional | | $314.85 | $445.30 | $1,127.82 |
- 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
- $356.82 / $665.14 / $997.60
| Professional | | $356.82 | $665.14 | $997.60 |
- 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
- $676.10 / $1,023.73 / $1,525.17
| Professional | | $676.10 | $1,023.73 | $1,525.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.10 / $635.16 / $1,715.52
| Facility | | $401.10 | $635.16 | $1,715.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.86 / $1,073.10 / $2,721.44
| Professional | | $648.86 | $1,073.10 | $2,721.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.49 / $1,162.28 / $2,842.49
| Facility | | $811.49 | $1,162.28 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.12 / $982.76 / $1,415.97
| Professional | | $735.12 | $982.76 | $1,415.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.12 / $674.97 / $1,066.14
| Professional | | $387.12 | $674.97 | $1,066.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,038.98 / $4,803.10 / $7,772.00
| Facility | | $4,038.98 | $4,803.10 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.86 / $1,106.67 / $1,397.54
| Professional | | $648.86 | $1,106.67 | $1,397.54 |