- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,089.30 / $10,471.29
| Facility | | $758.58 | $2,089.30 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,380.38
| Professional | | $489.78 | $602.56 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,344.23
| Facility | | $2,290.87 | $2,290.87 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,513.56
| Professional | | $478.63 | $724.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,318.26
| Professional | | $562.34 | $758.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,318.26
| Professional | | $912.01 | $912.01 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $724.44 / $1,096.48
| Facility | | $562.34 | $724.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $1,288.25
| Professional | | $831.76 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,332.54 / $14,454.40
| Facility | | $2,238.72 | $9,332.54 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $616.60 / $1,174.90
| Professional | | $478.63 | $616.60 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $45,708.82
| Facility | | $4,786.30 | $4,786.30 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $5,011.87
| Professional | | $4,168.69 | $4,168.69 | $5,011.87 |