- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,715.35 / $8,511.38
| Facility | | $478.63 | $3,715.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $478.63 / $1,380.38
| Professional | | $223.87 | $478.63 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $194.98 / $346.74
| Professional | | $190.55 | $194.98 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,311.31 / $6,760.83
| Facility | | $2,691.53 | $3,311.31 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,230.27 / $1,659.59
| Professional | | $741.31 | $1,230.27 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $933.25 / $2,344.23
| Professional | | $302.00 | $933.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $776.25 / $1,584.89
| Facility | | $213.80 | $776.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,584.89 / $6,025.60
| Professional | | $630.96 | $1,584.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,659.59 / $2,089.30
| Professional | | $549.54 | $1,659.59 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,230.27 / $2,089.30
| Professional | | $407.38 | $1,230.27 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $478.63 / $2,344.23
| Professional | | $3.98 | $478.63 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,162.28 / $8,128.31
| Facility | | $1,479.11 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $812.83 / $1,905.46
| Professional | | $309.03 | $812.83 | $1,905.46 |