- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,819.70 / $13,182.57
| Facility | | $660.69 | $1,819.70 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $891.25 / $1,819.70
| Professional | | $346.74 | $891.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $954.99 / $2,398.83
| Professional | | $524.81 | $954.99 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $2,137.96
| Professional | | $588.84 | $851.14 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,174.90 / $2,691.53
| Facility | | $436.52 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,412.54 / $2,137.96
| Professional | | $549.54 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,548.82 / $1,778.28
| Facility | | $1,230.27 | $1,548.82 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $977.24 / $2,137.96
| Facility | | $436.52 | $977.24 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $851.14 / $2,187.76
| Professional | | $79.43 | $851.14 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,302.69
| Facility | | $7,762.47 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,148.15 / $2,089.30
| Professional | | $645.65 | $1,148.15 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $12,882.50 / $26,302.68
| Facility | | $2,137.96 | $12,882.50 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $2,238.72
| Professional | | $524.81 | $1,096.48 | $2,238.72 |