- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $4,265.80 / $9,772.37
| Facility | | $562.34 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $524.81 / $1,862.09
| Professional | | $194.98 | $524.81 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $245.47 / $1,737.80
| Professional | | $93.33 | $245.47 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $6,165.95 / $12,589.25
| Facility | | $794.33 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $354.81 / $1,621.81
| Professional | | $177.83 | $354.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $2,238.72
| Facility | | $338.84 | $562.34 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $812.83 / $2,511.89
| Professional | | $239.88 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,691.53
| Professional | | $2,511.89 | $2,511.89 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $891.25 / $2,290.87
| Facility | | $213.80 | $891.25 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,908.68
| Facility | | $1,230.27 | $12,589.25 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $794.33 / $2,454.71
| Professional | | $190.55 | $794.33 | $2,454.71 |