- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.26 / $2,385.44 / $7,920.26
| Facility | | $511.26 | $2,385.44 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.87 / $541.00 / $1,732.42
| Professional | | $250.87 | $541.00 | $1,732.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.75 / $1,089.75 / $2,059.63
| Facility | | $1,089.75 | $1,089.75 | $2,059.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.32 / $739.01 / $2,183.13
| Professional | | $354.32 | $739.01 | $2,183.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.48 / $641.29 / $1,971.12
| Professional | | $436.48 | $641.29 | $1,971.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.73 / $754.76 / $2,030.59
| Facility | | $348.73 | $754.76 | $2,030.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.56 / $1,107.22 / $2,138.06
| Professional | | $394.56 | $1,107.22 | $2,138.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.30 / $1,403.70 / $1,642.84
| Facility | | $462.30 | $1,403.70 | $1,642.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.05 / $1,149.66 / $2,140.96
| Facility | | $351.05 | $1,149.66 | $2,140.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.25 / $1,040.65 / $2,170.65
| Professional | | $445.25 | $1,040.65 | $2,170.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.49 / $3,730.83 / $4,417.60
| Facility | | $2,830.49 | $3,730.83 | $4,417.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.65 / $1,294.42 / $2,195.60
| Professional | | $448.65 | $1,294.42 | $2,195.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.00 / $4,880.00 / $7,233.00
| Facility | | $1,472.00 | $4,880.00 | $7,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.24 / $1,562.38 / $2,629.74
| Professional | | $1,069.24 | $1,562.38 | $2,629.74 |