- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,951.21 / $7,413.10
| Facility | | $549.54 | $2,951.21 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $3,235.94
| Professional | | $380.19 | $912.01 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $2,137.96
| Professional | | $354.81 | $575.44 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $616.60
| Facility | | $389.05 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $3,467.37
| Professional | | $389.05 | $616.60 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $724.44
| Facility | | $467.74 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,630.27 / $2,754.23
| Professional | | $1,905.46 | $2,630.27 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $954.99 / $3,311.31
| Professional | | $371.54 | $954.99 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,884.03 / $9,772.37
| Facility | | $549.54 | $2,884.03 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $933.25 / $3,467.37
| Professional | | $407.38 | $933.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $3,311.31
| Professional | | $346.74 | $707.95 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,549.93 / $16,982.44
| Facility | | $5,128.61 | $9,549.93 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,148.15 / $2,344.23
| Professional | | $426.58 | $1,148.15 | $2,344.23 |