- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $6,025.60 / $10,471.29
| Facility | | $1,096.48 | $6,025.60 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $602.56 / $1,905.46
| Professional | | $398.11 | $602.56 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $616.60 / $812.83
| Professional | | $380.19 | $616.60 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $10,471.29
| Facility | | $4,073.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,023.29
| Professional | | $426.58 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $812.83 / $1,698.24
| Professional | | $436.52 | $812.83 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $676.08 / $1,479.11
| Facility | | $398.11 | $676.08 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,230.27 / $4,073.80
| Professional | | $616.60 | $1,230.27 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $1,548.82
| Professional | | $933.25 | $1,230.27 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $1,318.26
| Professional | | $691.83 | $1,023.29 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $562.34 / $1,479.11
| Professional | | $5.01 | $562.34 | $1,479.11 |
- 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
- $478.63 / $758.58 / $1,288.25
| Professional | | $478.63 | $758.58 | $1,288.25 |