- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.19 / $7,754.21 / $10,050.99
| Facility | | $699.19 | $7,754.21 | $10,050.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.72 / $479.65 / $820.73
| Professional | | $449.72 | $479.65 | $820.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.15 / $1,627.07 / $2,761.08
| Facility | | $1,479.15 | $1,627.07 | $2,761.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.94 / $708.37 / $1,242.21
| Professional | | $462.94 | $708.37 | $1,242.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $1,362.98 / $2,709.73
| Facility | | $515.00 | $1,362.98 | $2,709.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.87 / $668.00 / $1,198.64
| Professional | | $434.87 | $668.00 | $1,198.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $546.42 / $846.52
| Facility | | $443.00 | $546.42 | $846.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.00 / $611.00 / $1,125.35
| Professional | | $579.00 | $611.00 | $1,125.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.60 / $700.80 / $993.30
| Professional | | $512.60 | $700.80 | $993.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.32 / $519.91 / $1,149.28
| Professional | | $388.32 | $519.91 | $1,149.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,723.70 / $7,929.30 / $26,542.00
| Facility | | $2,723.70 | $7,929.30 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,460.72 / $3,460.72 / $4,207.43
| Professional | | $3,460.72 | $3,460.72 | $4,207.43 |