- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,513.56 / $7,585.78
| Facility | | $588.84 | $1,513.56 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $870.96 / $2,290.87
| Professional | | $371.54 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,513.56 / $6,606.93
| Professional | | $457.09 | $1,513.56 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $1,412.54
| Facility | | $501.19 | $851.14 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $891.25 / $3,801.89
| Professional | | $426.58 | $891.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Professional | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $870.96 / $3,467.37
| Facility | | $371.54 | $870.96 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Professional | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $1,905.46 / $7,244.36
| Professional | | $5.01 | $1,905.46 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,890.45 / $9,549.93
| Facility | | $912.01 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $812.83 / $3,548.13
| Professional | | $354.81 | $812.83 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $9,332.54 / $9,332.54
| Facility | | $56.23 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,125.38 / $15,488.17 / $15,488.17
| Professional | | $14,125.38 | $15,488.17 | $15,488.17 |