- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,884.03 / $7,762.47
| Facility | | $758.58 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $851.14
| Professional | | $389.05 | $467.74 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,128.61 / $9,120.11
| Facility | | $2,454.71 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $758.58 / $851.14
| Professional | | $512.86 | $758.58 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $851.14
| Professional | | $363.08 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $1,819.70
| Professional | | $416.87 | $676.08 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $562.34
| Professional | | $489.78 | $512.86 | $562.34 |
- 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
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $891.25
| Professional | | $407.38 | $524.81 | $891.25 |