- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $3,090.30 / $4,570.88
| Facility | | $575.44 | $3,090.30 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $1,513.56
| Professional | | $416.87 | $549.54 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $912.01 / $2,137.96
| Professional | | $426.58 | $912.01 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,479.11 / $2,344.23
| Facility | | $1,258.93 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,479.11 / $1,698.24
| Professional | | $645.65 | $1,479.11 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,884.03 / $5,370.32
| Facility | | $467.74 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $1,380.38
| Professional | | $831.76 | $1,148.15 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $5,495.41 / $8,317.64
| Facility | | $467.74 | $5,495.41 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $3,467.37
| Professional | | $436.52 | $741.31 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $575.44
| Professional | | $32.36 | $33.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,096.48 / $1,659.59
| Professional | | $562.34 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,137.96 / $3,388.44
| Professional | | $630.96 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,570.40 / $2,818.38
| Professional | | $933.25 | $2,570.40 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $1,862.09
| Professional | | $407.38 | $676.08 | $1,862.09 |