- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,344.23 / $5,011.87
| Facility | | $575.44 | $2,344.23 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $1,288.25
| Professional | | $239.88 | $331.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,025.60 / $7,762.47
| Facility | | $3,715.35 | $6,025.60 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $512.86
| Professional | | $251.19 | $331.13 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $416.87
| Professional | | $208.93 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $2,691.53
| Professional | | $186.21 | $288.40 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $2,691.53
| Professional | | $323.59 | $323.59 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $234.42
| Professional | | $213.80 | $213.80 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $436.52
| Professional | | $229.09 | $295.12 | $436.52 |